الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Acute myocardial infarction (AMI) is a common disease with serious consequences in mortality, morbidity, and cost to the society. Coronary atherosclerosis plays a pivotal part as the underlying substrate in many patients. Acute myocardial infarction has always been a potential health problem due to the life-threatening complications.The WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project show that acute coronary syndromes are the most prevalent cause of death in patients hospitalized for medical conditions (104) .
Our study included 100 patients with STEMI admitted tosohag university hospital, coronary care unit. It include 50 patients received thrombolytic therapy & 50 patients didn’t receive thrombolytic therapy for whom elective coronary angiography done .
Both male & female included in the study with percentage (82%) for male & (18%) for female . males are more liable for the incidence of myocardial infarction.
The incidence of STEMI is more in old age which is also risk factor for atherosclerosis ,diabetes mellitus & hypertension.
According toour study which included100 patients with STEMI, hypertension is presented by (69%) of patients, DM presented by (76%) of patients,current smokers were (53%) of patients, past history of IHD (52%), family history of IHD (63%). These are the most common risk factors of myocardial infarction.
We found that 70 % of STEMI patients presented by typical compressing retrosternal chest pain ( at least 30 minutes ).
According toour study which included100 patients with STEMI ,about 53 % of patients had hypercholesterolemia>200 , about 58 % had LDL >100mg/dl & 60 % had HDL <40mg/dl so we concluded that hyperlipidaemia is significant risk factor.
About 46 % patients presented by anterior STEMI,20 % patients presented by inferior STEMI .
We found that the use of thrombolytic therapy decreases the incidence of heart failure About 32 ( 64.00%) patients who received theombolytic therapy didn’t develop heart failure & only 18 ( 36.00% ) developed heart failure
The culprit artery determined from angiographic characteristics of obstructive lesions (obstruction due to thrombus formation in STEMI) with decreased contrast density.
from our results,we detected that multiple vessel affection is more than single vessel affection.
According to our study which included 100 patients with STEMI , the incidence of TIMI 0,TIMI 1 more in patients who didn’t receive thrombolytic therapy &TIMI 2 & TIMI 3 more in patients who received thrombolytic therapy .
About 73 % of STEMI patients have intermediate TIMI risk index( TRI ), 15% of patients have low TRI & 12% of patients have high TRI
We detected that thrombolytic therapy doesn’t cause significant improvement in the degree of stenosis & hence revascularization is very important .
Conclusions
The cornerstone of management in ST elevation ACS is the timely restoration of flow in the infarct related artery. The accepted strategies for reperfusion include primary PCI and thrombolysis. If available within a timely fashion from an experienced team, urgent coronary angiography and primary percutaneous coronary intervention (PCI ) offers better patient outcomes than thrombolysis. In addition, primary PCI is recommended in patients with cardiogenic shock or contraindication to thrombolysis.
In patients with failed thrombolysis, or recurrent ischemia after initially successful
thrombolysis, urgent coronary angiography should be considered.
Coronary angiography provides important diagnostic& prognostic information in patients admitted with STEMI who received thrombolytic therapy or not.
Coronary angiography give good idea about the need for coronary revascularization surgery after thrombolytic therapy.
Study limitation:
1-The small number of patients.
2-Lag time between ACS and coronary angiography may affect the coronary angiography finding.
3-The use of streptokinase is associated with more compliacations than other recent thrombolytic therapies .