Age-Stratified Safety And Effectiveness Of Streptokinase In Acute Myocardial Infarction: A Retrospective Cohort Study From Sudan

Abstract

Background: Streptokinase (SK) remains widely used for thrombolysis in acute myocardial infarction (AMI) across low-resource settings. Despite its affordability and accessibility, concerns persist regarding its efficacy in elderly patients, those with delayed presentation, and individuals with prior SK exposure. Objective: To evaluate the safety and effectiveness of SK in AMI management in Sudan, with emphasis on age-related outcomes, aspirin co-administration, and comorbidities such as diabetes mellitus. Methods: A retrospective analysis was conducted on 100 AMI patients treated with SK at a tertiary hospital in Sudan. Data were stratified by age, time-to-presentation, prior SK exposure, and comorbid conditions. Outcomes included symptom resolution, adverse drug reactions (ADRs), and in-hospital mortality. Results: SK demonstrated consistent efficacy across age groups, with no significant reduction in therapeutic response among elderly patients (OR = 1.12, p = 0.81) or those with delayed presentation. Aspirin co-administration significantly improved outcomes and reduced ADR incidence (OR = 3.21, p < 0.001). Prior SK exposure did not compromise efficacy. ADRs were observed in 51% of patients, with hypotension (21%), arrhythmias (7%), and fever (6%) being the most common. Diabetic patients exhibited higher complication rates and suboptimal thrombolytic response (OR = 0.48, p = 0.032), highlighting the need for tailored adjunctive therapies. Conclusion: SK remains a safe, effective, and accessible thrombolytic agent for AMI management in Sudan. Its performance is enhanced by aspirin and unaffected by age or prior exposure. Diabetes mellitus presents ongoing challenges, warranting further research into personalized treatment strategies. These findings support revisions to national AMI guidelines and underscore the importance of context-specific thrombolytic protocols in resource-constrained environments