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Thrombolytic therapy in myocardial infarction
Insights
Streptokinase administration for myocardial infarction significantly reduces mortality by 18% and improves survival rates. Further research is needed for more potent thrombolytic drugs with fewer side effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Streptokinase, reintroduced in 1979, revolutionized myocardial infarction treatment.
- Thrombolytic therapy aims to recanalize occluded coronary arteries post-infarction.
Purpose of the Study:
- To review the efficacy and safety of streptokinase and recombinant tissue plasminogen activator (rt-PA) in myocardial infarction.
- To discuss complications and future directions in thrombolytic therapy.
Main Methods:
- Review of clinical studies including GISSI and ISIS-2.
- Comparison of streptokinase with rt-PA regarding recanalization, survival, and left ventricular function.
Main Results:
- Intravenous streptokinase showed an 18% mortality reduction (GISSI study).
- Aspirin addition improved survival (ISIS-2 study).
- rt-PA achieved higher patency rates and improved survival compared to streptokinase.
Conclusions:
- Thrombolytic therapy, including streptokinase and rt-PA, improves survival and left ventricular function in myocardial infarction.
- Complications include intracranial hemorrhage and bleeding; reinfarction risk necessitates ischemia assessment.
- Development of more effective and safer thrombolytic agents is ongoing.
Abstract:
Since its reintroduction in 1979, the administration of streptokinase for the treatment of myocardial infarction has revolutionised the management of this common condition. Intracoronary, and subsequently intravenous infusion of this lytic agent have been shown to recanalise the totally occluded infarct related vessel. Overall mortality reduction was 18% when it was administered intravenously in the GISSI study. The survival advantage has been maintained over 1-2 years. The addition of aspirin has increased the survival rate, as reported in the ISIS-2 study. Recombinant tissue plasminogen activator, a clot specific agent, achieves a higher patency rate when compared to streptokinase, besides favourably influencing survival. Both drugs also improve left ventricular function. Complications include a 0.5-1% incidence of intracranial haemorrhage, as well as a small risk of major bleeding. Although the incidence is low, reinfarction is increased after thrombolytic therapy. Hence, some form of assessment of residual myocardial ischaemia should be performed. Routine PTCA after thrombolysis has not been shown to be of additional benefit. The introduction of more potent and clot specific drugs without unwanted side effects are eagerly awaited.