الفهرس 
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Abstract
Despite That Primary Percutaneous Coronary Intervention (PPCI) Is More Effective Than Thrombolytic Therapy Alone When Delivered By An Experienced Team Soon After Symptom Onset, In Our Developing Countries Frequent Delays To PPCI Are Standing Against The Perfect Time Of Myocardium Reperfusion. In Our City, Delay Of Reperfusion Is Due To Many Reasons: 1) City Traffic; As STEMI Patients Cannot Reach PCI Capable Hospital In An Appropriate Time. Also Many Patients Are Getting There By Taxi Or By Their Own Cars. Unfortunately, Ambulances Are Minimally Used To Transfer STEMI Patients To Hospitals. 2) Lake Of Patients’ Awareness By STEMI Symptoms And The Importance Of Getting To Hospital For An Early Reperfusion. This Delay Adversely Affects Outcomes.
Traditionally, Streptokinase Has Been The Most Commonly Used Fibrinolytic Agent Around The World. Recently, There Is Some Favorable Evidence For Using Fibrin Specific Thrombolytic Agents In Many Countries. Unlike Streptokinase, These Agents Have The Advantage Of Being Fibrin Specific Can Be Given As A Bolus Dose With A Lower Incidence Of Hypersensitivity Reactions. According To ACCF/AHA Guideline Regarding The Choice Of Fibrinolytic Agent For Management Of ST-Elevation Myocardial Infarction, Fibrin-Specific Agents Are Preferred When Available. However, Streptokinase Is Still The Only Available Thrombolytic Agent In Egypt Because Of Its Cheap Coast Comparing To Other Fibrin-Specific Thrombolytic Agents.
Our Study Aimed To Assess The Efficacy And Safety Of Streptokinase As A Pharmaco-Invasive Reperfusion Therapy Comparing To The Primary Percutaneous Intervention In ST-Segment Elevation Myocardial Infarction In Egypt.
Method
• All Patients Arrived During Working Hours (from 8:00 Am To 5:00 Pm) Underwent Primary PCI.
• All Patients Arrived After Working Hours (from 5:30 Pm To 7:30 Am) Received SK Followed By CA.
• STEMI Patients Who Reached A Non-PCI Capable Hospital Received Streptokinase And Were Transferred To The Hospital For Coronary Angiography.
• Based On The Reperfusion Time, Every Arm Was Divided Into Two Subgroups;
Early Reperfusion (≤3h from The Onset Of Symptoms).
Late Reperfusion (>3h from The Onset Of Symptoms).
• Echocardiographic Examination Was Done For All Patients. Ejection Fraction (EF), LV Dimensions And Segmental Wall Motion Abnormality (SWMA) Was Measured. Final TIMI Flow Grade Result (TFG) Was Obtained. Bleeding Complications Were Also Observed And Evaluated. All Patients Were Followed-Up For 30 Days.
Our Study Showed The Following Results;
• In Our Study, There Was No Statistical Significant Difference Regarding The LVEF Result In Both PPCI And PI Arms (P=0.764).
• Early PPCI Preserves LVEF Better Than Early And Late PI (P= 0.042).
• PI Had More Myocardium Wall Preservation When Comparing To PPCI Arm, It Showed Statistical Difference; (P= 0.033).
• Early PI Reperfusion group (≤ 3hrs) Had More Preserved Walls; (P=0.004) Comparing To Early PPCI.
• Early And Late Reperfusion Subgroups In Both Arms Showed The Same Incidence Of Open Vessels Reaching TIMI G3 And TIMI G2 (P=0.750).
• The Suction Device Was Used In 4.3% (N=2) Patients In Early Reperfusion By PI Comparing To Early PPCI Group; 19.6% (N=10).
• The Real Difference Had Shown In Late PPCI Versus Late PI Group; 21.5% (N=17) Vs. 9 % (N=8).
• In Late Reperfusion By PI Approach, Only 8 (9.1%) Patients Need IV Eptifibatide In Catheterization Laboratory Comparing To 17 (21.5%) Patients In Late PPCI (P=0.003).
• The Best Cut Off Value For Time To Primary Percutaneous Coronary Intervention As A Reperfusion Strategy Is 2.75 Hours And The Best Cut Off Value For Time To Receive Streptokinase from The Onset Of Symptom Is 2.25 Hours. The Best Cut Off Value For Time To Coronary Angiography After A Reperfusion With Streptokinase Is 24.75 Hours. This Value In Which Is Preserve The Best LVEF In Its Accepted Normal Values.