Original Article Role of thrombolytic therapy in young adult smokers with acute ST-elevation myocardial infarction 5 Shiva Kumar Yerra a , Siddarth Mathur b , Divya Pandiri c, *, Vived Kumar Turai c , Lakshmi S. Dandu c , Syed Ata Ur Rahman c a Senior Consultant Cardiologist, Mahavir Hospital and Research Center, Hyderabad, Andhra Pradesh, India b Clinical Cardiologist, Mahavir Hospital and Research Center, Hyderabad, Andhra Pradesh, India c Doctor of Pharmacy, Bharat Institute of Technology-Pharmacy, Mangapally (V), Ibrahimpatnam (M), Associated with Krishna Institute of Medical Sciences Hospital & Research Centre, Hyderabad, Andhra Pradesh, India article info Article history: Received 3 September 2013 Accepted 5 September 2013 Keywords: Acute STEMI PCI TLT Smoking abstract Introduction: STEMI is a major cause of cardiovascular mortality worldwide. Smoking seems to be the most common risk factor seen in both young and the old population. Athero- sclerotic plaques are more commonly seen in older population. In young smoking adults the clots are not atherosclerotic. As smoking causes endothelial injury along with “sticky phenomenon”, where the fibrin sticks together in presence of thrombin and forms clots. The thrombolytic efficiency lays in its specificity to fibrin. This makes thrombolytic drugs the preferential treatment in young adults due to their clots (fibrin and thrombin) than older patient’s atherosclerotic plaques (cholesterol, fibrin and thrombin). Method: Only patients diagnosed with acute STEMI and treated with Thrombolytic therapy were included in this study. Results: Our study showed that TLT was effective in recanalising the infarct related artery in the young adult smokers when compared to the old adults with acute STEMI. Age is a statistically significant variable (p < 0.0001), where the percentage of recanalised patients increases with decreasing age (i.e., young patients recanalise more than the older patients). Also the effect of smoking on recanalisation of the culprit coronary artery is statistically significant (p ¼ 0.056). And when we look at the group of young adults, the effect of smoking on number of recanalisations has an odds ratio of 2.57, which can be interpreted as, smokers are 2.57 times are likely to recanalise the infarct related artery when compared to non-smokers. Conclusion: Although Percutaneous Coronary Intervention (PCI) has been proven beneficial over TLT in management of acute STEMI, thrombolytics are recanalising the younger pa- tients better than the older patients. TLT has a special place in young smokers as it targets 5 The abstract of the study was presented at 7th Asian Conference on Pharmacoepidemiology 2012 in Bengaluru, India. The disser- tation was also presented & has won consolation prize at National Seminar on emerging trends, challenges & Innovative approaches in Clinical Research in India held at Hyderabad on April 2013. * Corresponding author. Mahavir Hospital and Research Center, 10-1-1, Bhagwan Mahavir Marg, AC Guards Flyover, Masab Tank, Hyderabad, Andhra Pradesh, India. Tel.: þ91 9966658762. E-mail address: divyapandiri3@gmail.com (D. Pandiri). Available online at www.sciencedirect.com journal homepage: www.elsevier.com/locate/jicc journal of indian college of cardiology 3 (2013) 99 e103 1561-8811/$ e see front matter Copyright ª 2013, Indian College of Cardiology. All rights reserved. http://dx.doi.org/10.1016/j.jicc.2013.09.003