EFFICACY AND SAFETY OF TENECTEPLASE (METALYSE) IN IRAQI PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION

Background- Thombolytic therapy using tissue plasminogen activator has revolutionized the treatment of acute myocardial infarction. Tenecteplase was developed as a bioengineered variant of tissue-type plasminogen activator with specific, desirable properties. The aim of this study is to assess the efficacy and safety of tenecteplase in patients with AMI.
Methods- 50 patients with acute STEMI were enrolled in this study; those patients had presented to the hospital within 12 hours of the onset of their chest pain and fulfilled the criteria of starting thrombolytic therapy. They had been randomly selected consecutive patients from those attending the coronary care unit of Al-Yarmouk Teaching Hospital, Baghdad during the period from October 2005 to August 2006. Tenectaplase infusion over ten seconds was given according to body weight. ST-segment resolution was defined as reduction in the ST-elevation of 50% or more at 90 minutes.
Results- 40 patients (80% of the sample) were male. The range of patients’ age was 28-80 years, with a mean of 54.94 ± 10.83 years and a median of 53 years old. ST- segment resolution had been observed in 27 patients (54% of the sample). The mean age of those with successful thrombolysis was 52.78 ± 10.8 years old, and 59.13 ± 10.3 years old for those who failed to respond to the thrombolytic therapy with tenecteplase. Statistical analysis revealed a highly significant effect of age on the frequency of ST-segment resolution (calculated t= 24.78, p-value <0.0001). The mean time to perfusion was 2.4 ± 2.37 hours and 4.76 ± 3.25 hours for those with successful thrombolysis and those who failed to respond, respectively. Eight out of 12 patients diagnosed with inferior STEMI had successful reperfusion. No one with double wall infarction had successful reperfusion. Two patients with diabetes (15.4%) and only 1 patient with hyperlipidemia (11.1%) had successful thrombolysis. None of those with 3 or more risk factors (7 patients) had successful reperfusion. The study showed that female patients had a higher chance of failure of thrombolysis.