Killip classification and baseline heart rate can be used to predict streptokinase‐induced hypotension in acute myocardial infarction

Abstract. Streptokinase is the thrombolytic therapy of choice for acute myocardial infarction in hospitals without cardiac facilities. Streptokinase‐induced hypotension is one of the common adverse drug reactions and is usually observed within 30 min of an intravenous streptokinase infusion. The present study aimed to identify predictive clinical parameters for the development of hypotension in patients with acute myocardial infarction. The present retrospective study involved data tran‐ scription from National Indicator Approach (NIA) records of acute myocardial infarction recorded between 2015 to 2018. Multivariate analysis was performed to evaluate potential predic‐ tors of streptokinase‐induced hypotension and to determine the association between selected clinical variables in patients with streptokinase‐induced hypotension. The present study included a total of 412 patients with acute myocardial infarction adminis‐ tered streptokinase. The majority (n=258, 62.6%) did not develop any complication from the therapy, whereas 109 (26.5%) devel‐ oped hypotension at 18.5 (interquartile range, 10.00) min from the initiation of therapy. Multiple logistic regression analysis revealed that with every one‐unit increment in the baseline heart rate, the risk of hypotension was reduced by 2.6%. Additionally,patients classified as Killip class III and IV were at an increased risk (5‐fold) of developing hypotension as compared with those classified as Killip I. Therefore, as demonstrated herein, these predictive factors may assist clinicians in identifying susceptible individuals and may encourage vigilance when delivering streptokinase therapy.