Comparative Efficacy between Streptokinase, Tenecteplase and Reteplase in ST Elevated Myocardial Infarction among Patients Attending Tertiary Care Hospital of Odisha

Introduction: ST Elevation Myocardial Infarction (STEMI) is one of the most fatal emergencies contributing to significant morbidity and mortality due to coronary artery disease. Fibrinolytic agents are most effective agents used for the management of STEMI. However, there is a relative paucity of data comparing the effectiveness of thrombolytic agents that can provide insight for proper selection of this class of drugs. Aim: To compare the efficacy of streptokinase, tenecteplase, and reteplase in patients of STEMI in terms of post-thrombolytic resolution by observing reduction of ST-segment elevation at 90 minutes of thrombolytic and assessing for mortality within 30 days of therapy. Materials and Methods: This prospective, single-centre, observational, hospital-based study was conducted in the Department of Cardiology in collaboration with the Department of Pharmacology at Srirama Chandra Bhanja Medical College and Hospital, Odisha, India, from February 2020 to January 2022. The study involved 300 patients (100 patients in each group) being treated with streptokinase, or tenecteplase,or reteplase. A reduction of ≥50% of the initial ST elevation was considered as successful thrombolysis. The efficacy of the thrombolysis with these agents was assessed based on the extent of ST resolution in Electrocardiogram (ECG) at 90 minutes and observing 30 day mortality thereafter. Categorical data were evaluated using Chisquare test and the means were evaluated using Analysis of Variance (ANOVA). Results: There was no statistically significant difference between the three groups with respect to ST segment reduction. At 90 minutes of thrombolysis, 75%, 76%, 72% patients showed reduction in the ST segment in the Streptokinase, Tenecteplase and Reteplase group, respectively (p-value=0.79). A total of 9, 5 and 8 deaths were seen in the streptokinase, tenecteplase and reteplase group, respectively within a span 30 days (p-value=0.52). Conclusion: Streptokinase, tenecteplase and reteplase were equally efficacious for thrombolysis in terms of thrombus resolution and preventing mortality, when started early.