Thrombolytic Therapy for ST-Elevation Myocardial Infarction and High-Risk Pulmonary Embolism in a Non-percutaneous Coronary Intervention-Capable Hospital

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Introduction ST-elevation myocardial infarction (STEMI) and pulmonary embolism (PE) are common life-threatening emergencies encountered in clinical practice. Options for reperfusion therapy are often unavailable in resource-limited settings like Ghana. We present a review of our 19-month experience with systemic thrombolysis for patients with STEMI and hemodynamically unstable PE in Tamale Teaching Hospital (TTH) in Tamale, Ghana. Methods We retrospectively reviewed patients ≥ 18 years old with acute STEMI and PE managed in TTH from January 2023 to July 2024. STEMI was defined using standard criteria. Systemic thrombolysis was administered to eligible STEMI patients presenting within 12 hours of symptom onset. Hemodynamically unstable PE was defined as persistent hypotension (systolic blood pressure <90 mmHg for longer than 15 minutes), obstructive shock, or the need for cardiopulmonary resuscitation. We assessed treatment timelines, complications, and in-hospital outcomes. Results Of 42 patients with a mean age (± SD) of 56.6 ± 16.7 years with STEMI, 25 (59.5%) were male. Seven (16.7%) patients received systemic thrombolysis as the primary reperfusion strategy. For patients with STEMI, the median delay from symptom onset to first medical contact (FMC) was 10 hours (IQR 3.0-42.0), whilst the delay from FMC to thrombolysis was four hours (IQR 2-5 hours). Seventy-six patients with a mean age of 53.0 ± 18.1 years had confirmed pulmonary embolism, of which 35 (46.1%) were male. Systemic thrombolysis was administered to five hemodynamically unstable patients. Cost considerations largely determined the choice of thrombolytic agent used. Adverse events following thrombolysis included four cases of allergic reactions (all with streptokinase), two patients with minor bleeding involving skin puncture sites, and one patient with bleeding from the urethral meatus. Conclusion Reperfusion therapy for STEMI and PE remains challenging in resource-limited settings like Ghana. Systemic thrombolysis is feasible but is limited by systemic challenges, including the high cost of fibrin-specific thrombolytic agents and late presentation. Strategies to promote early presentation and timely thrombolysis, such as community education, access to timely electrocardiogram interpretation, and sustainable financing models, are needed.

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