Introduction ST-Elevation Myocardial Infarction (STEMI) accounted for 43.3% of Acute Coronary Syndromes (ACS) in Malaysia in 2019. Malaysia uses thrombolysis, specifically streptokinase, for acute STEMI reperfusion, even though Primary Percutaneous Coronary Intervention (PPCI) is the gold standard. This study investigates thrombolysis results and Primary Percutaneous Coronary Intervention (MACE) risk variables.

Methods This retrospective observational analysis included acute STEMI patients treated with streptokinase for thrombolysis in 2021. Patient demographics, comorbidities, treatment, angiography and echocardiography results, treatment issues, and blood investigation data were collected and analysed using SPSS.

Results Accordingly, 150 patients evaluated had 84% thrombolysis success. Most patients were male (88.7%) and Malay (55.3%), with a mean age of 56.76 years (SD 10.23). Males had greater success rates (OR = 0.287, 95% CI = 0.094–0.872), and patients under 45 had reduced thrombolysis failure rates (p = 0.001). STEMI patients with hypertension, CKD, and DM had higher fatality rates (p = 0.02, 0.003, and 0.002). Left anterior descending artery infarcts demonstrated a greater thrombolysis success rate, though not statistically significant. Thrombolysis within 4 hours of symptom onset was more efficacious (62.7%, p = 0.003). The most prevalent consequences were cardiogenic shock (20.7%) and acute pulmonary oedema (17.3%). In unsuccessful thrombolysis, arrhythmia was more common (p < 0.001), and patients had greater risks of death and cardiac arrest (6.7% vs. 2.7%, p < 0.001). The cardiogenic shock occurred in 8.7% of failed thrombolysis patients and 13.3% of successful patients (p = 0.002).

Discussion Research indicates that effective STEMI thrombolysis in Malaysia is linked to age <45, male gender, and symptom onset to thrombolysis time <4 hours. In particular, thrombolysis failure is strongly associated with female gender, CKD, arrhythmia, cardiogenic shock, and cardiac arrest. Meanwhile, high fatality rates are linked to female DM, hypertension, CKD, and symptom onset to thrombolysis delays above 4 hours.

Conclusion In Malaysia, timely STEMI thrombolysis, particularly within four hours of symptom onset, is crucial for enhancing patient outcomes. Prompt treatment significantly reduces the risk of severe complications and increases the chances of a successful recovery.