Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic: A systematic review and meta-analysis

A, Arunachalam AS, M. A. A, Palani BP, Raveendiran B, Sundaram B, Majella CM, Perumal J, Jeemon P, Ganesan K, Balasubramani K, Kumaresan K, Perumal K, Radhakrishnan K, Srinivasan K, Ganesan M, Tamilmani M, Azhakesan M, K. N, Mohandoss NP, Jayabalan N, Mohanan N, Padmnabhan P, Mohamed RB, Sethumadhavan R, Edwin R, Kannappan S, Gnanamuthu S, Krishan SR, Satish SP, Ahamed D, Jagannathan R. Impact of telemedicine in STEMI care system: A five-year experience from Tamil Nadu, India

Background & objectives Timely reperfusion reduces mortality in ST-segment elevation myocardial infarction (STEMI). Telemedicine and social media have been shown to improve STEMI care in community settings as reported previously. We established a government-sponsored STEMI care system in the State of Tamil Nadu with a goal of enhancing guideline-directed revascularisation (GDR) in STEMI. This study aimed to improve GDR by networking non-percutaneous coronary intervention (PCI)-capable hospitals with PCI capable hospitals in a hub-and-spoke model and implementing telemedicine through social media groups. Methods Eighteen Government medical college hospitals were provided cardiac catheterisation laboratories and linked to 188 Taluk and non-PCI capable Government hospitals forming 18 STEMI clusters. Telemedicine guidance on STEMI management was provided through WhatsApp groups created for each cluster. Cumulative daily data on the number of STEMIs, the revascularisation provided, and mortality were collected through free online web forms. Annual cumulative data on STEMI volumes and GDR were analysed. Results A total of 71,907 individuals were treated for STEMI from 2019 to 2023. A 67 per cent annual increase in the total individuals treated for STEMI was observed. The proportion of individuals receiving pharmaco-invasive therapy (PIT) increased from 7.9 to 31.7 per cent. There was a 68 per cent increase in the individuals receiving primary PCI. The number of individuals without GDR decreased by 20 per cent. There was a 6.7-fold rise in the individuals referred from spoke to hub hospitals for catheter-based revascularization. Overall mortality showed a marginal decrease from 8.7 to 8.4 per cent. Interpretation & conclusions Findings of this study suggest that a government-sponsored STEMI care system in a hub-and-spoke model, guided by telemedicine through social media groups will improve GDR in STEMI care in developing nations.

Successful Rescue of Ventricular Fibrillation Electrical Storm Secondary to Acute Myocardial Infarction in a Patient Presenting to a District General Hospital: A Case Report

Ventricular arrhythmia is a critical and challenging cardiovascular complication of myocardial infarction (MI). An electrical storm (ES), characterised by three or more episodes of sustained ventricular arrhythmia within 24 hours, poses a significant life-threatening risk. Standard management includes advanced life support (ALS) protocols and specialised pharmacological interventions. We present the case of a 43-year-old female who presented to the emergency department (ED) following an out-of-hospital ventricular fibrillation (OOHVF) arrest, with the return of spontaneous circulation (ROSC) achieved after multiple defibrillation shocks. Electrocardiography (ECG) revealed anterior ST-segment elevation MI (STEMI) involving the left anterior descending (LAD) artery. During her ED stay, she experienced recurrent ventricular fibrillation (VF) arrests requiring repeated defibrillation, adrenaline, amiodarone, and thrombolysis with alteplase. She was subsequently intubated and transferred to a primary percutaneous coronary intervention (PPCI) centre with intensive care support. Angiography confirmed a 100% occlusion of the LAD, which was successfully treated with stenting. The patient was admitted to the intensive care unit (ICU) and later discharged with full neurological recovery, on secondary prevention and heart failure therapy, with follow-up planned. This case underscores the complexity of managing electrical storms in MI, particularly in non-PPCI centres. It emphasises the importance of thrombolysis as an early reperfusion strategy in STEMI, especially when PPCI is not immediately available.

Favorable factors for the survival of ST-segment elevation myocardial infarction patients with medium- and high-risk thrombolysis in myocardial infarction scores

OBJECTIVE

ST-segment myocardial infarction (STEMI) is a time-sensitive emergency. This study screened the favorable factors for the survival of STEMI patients with medium- and high-risk thrombolysis in myocardial infarction (TIMI) scores.

METHODS

According to the TIMI scores at admission, 433 STEMI patients were retrospectively and consecutively selected and allocated into low-/medium-/high-risk groups, with their general information/blood routine/biochemical indicators/coagulation indicators documented. The factors influencing the in-hospital survival of STEMI patients were analyzed using univariate and multivariate logistic regression analyses. Moreover, the predictive value of favorable factors was analyzed by receiver operating characteristics (ROC) curve, and patients were assigned into high/low level groups based on the cut-off value of these factors, with their in-hospital survival rates compared.

RESULTS

The in-hospital survival rate of the medium-/high-risk groups was lower than that of the low-risk group. Emergency percutaneous coronary intervention (PCI), lymphocyte (LYM), total protein (TP), albumin (ALB), and sodium (Na) were independent favorable factors for in-hospital survival in the medium-/high-risk groups. Besides, LYM > 1.275 × 109/L, TP > 60.25 g/L, ALB > 34.55 g/L, and Na > 137.9 mmo1/L had auxiliary predictive value for the survival of STEMI patients with medium-/high-risk TIMI scores. Patients with high levels of LYM, TP, ALB, and Na exhibited higher in-hospital survival rates than patients with low levels.

CONCLUSION

For STEMI patients with medium- and high-risk TIMI scores, accepting emergency PCI and normal levels of LYM, TP, ALB, and Na were more conducive to in-hospital survival.