Streptokinase as an Effective Drug in Safeguarding the Lives Of Syrian Patients With Myocardial Infarction During The Syrian Crisis

Throughout the protracted years of conflict in Syria, which precipitated a profound economic and humanitarian crisis, the nation also witnessed the disintegration of its public healthcare system. This breakdown severely hampered the ability to adhere to established international protocols for managing myocardial infarction cases. Consequently, a national protocol was established whereby streptokinase is prioritised as the initial treatment strategy in all public hospitals. This approach has demonstrated its efficacy in preserving the lives of thousands of patients with STEMI.

This cross-sectional study included 185 patients seeking care at the emergency department. The study spanned six months between 2022 and 2023. All included participants presented with STEMI and experienced chest pain within the first 24 hours of symptom onset. Streptokinase therapy was initiated promptly for all patients.

Clinical response and ECG results one hour after streptokinase treatment revealed a reduction in chest pain and ST-segment elevation. Among 145 patients, 77.5% experienced improvement, while 40 patients, representing 22.5%, showed no benefit from the treatment. Among the study patients treated with streptokinase, 152 underwent cardiac catheterisation to assess the condition of their coronary arteries and determine the next steps for interventional treatment, while 33 did not undergo coronary angiography. Among those who underwent angiography, the majority benefited from streptokinase treatment, as 69.5% (n=129) of patients showed a patent target artery with favourable blood flow outcomes (TIMI 2-3).

Streptokinase, recognised as the first generation of thrombolytic agents, has become infrequently utilised in many countries, particularly within low-income settings, where its cost-effectiveness makes it a viable option for thrombolytic therapy. However, during the Syrian conflict, the constrained medical landscape rendered streptokinase the sole thrombolytic option in many hospitals. Consequently, it was adopted as the primary emergency treatment in all public hospitals. This shift was necessitated by a severe shortage of essential materials and the unavailability of adequate equipment required for emergency coronary interventions.

Early intravenous fibrinolysis improves survival in patients with STEMI, as improvement in global LV function, like survival, is related to the time of initiation of fibrinolytic treatment, with the greatest improvement occurring with the earliest therapy. This conclusion stems from our experience treating thousands of patients in Syrian public hospitals over a decade, during the tumultuous period of the Syrian revolution and ongoing war.