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Streptokinase versus alteplase: comparison of echocardiographic parameters and post-coronarography treatment--our
Nerma Resic1, Azra Durak-Nalbantic2, Alen Dzubur2
1Clinic for Heart disease and rheumatism, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina. resicnerma@yahoo.com
Insights
Alteplase showed better outcomes than streptokinase in acute myocardial infarction (AMI) patients, especially when administered within 1.5 hours. Early alteplase treatment reduced diastolic dysfunction and mitral regurgitation.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Fibrinolytic therapy is crucial for reperfusion in acute myocardial infarction (AMI), aiding in myocardial salvage and patient recovery.
- Streptokinase and alteplase are common fibrinolytic agents used in AMI management.
Purpose of the Study:
- To compare the efficacy of streptokinase versus alteplase in reperfusion for AMI.
- To analyze echocardiographic parameters and post-coronary angiogram treatment strategies in AMI patients receiving different fibrinolytic therapies.
Main Methods:
- A study involving 53 AMI patients divided into streptokinase and alteplase groups.
- Subgroup analysis based on time from chest pain onset to clinic admission.
- Echocardiographic assessment of mitral regurgitation, left ventricular systolic/diastolic function, and ischemic cardiomyopathy.
- Coronary angiogram analysis for disease severity and treatment recommendations.
Main Results:
- Alteplase group showed significantly less diastolic dysfunction compared to streptokinase (p=0.037).
- When treated early (within 1.5 hours), the alteplase group had more patients managed with medication alone (62.5% vs 28.6%, p=0.047).
- Early alteplase treatment was associated with lower mitral regurgitation incidence (p=0.045), reduced cardiomyopathy development (p=0.009), and better preserved left ventricular diastolic function (p=0.008).
Conclusions:
- Significant differences in echocardiographic parameters and post-treatment strategies were observed between streptokinase and alteplase, particularly when considering early administration.
- Patients treated with alteplase within 1.5 hours of chest pain onset demonstrated the most favorable outcomes.
Introduction:
Usage of fibrinolytic therapy leads to reperfusion of the occluded coronary arteries, rescue of ventricle myocardium and successful recovery of patient.
Goal:
The objective of this study was to compare the reperfusion effect of streptokinase and alteplase in acute myocardial infarction (AMI) by analyzing echocardiographic parameters and post-coronarography treatment.
Patients And Methods:
We observed 53 patients in AMI and divided them depending on applied therapy in streptokinase and alteplase group. Both groups were further divided into three subgroups depending on the time passed from chest pain occurrence to admission at Clinic. Observed echocardiographic parameters were: mitral regurgitation, left ventricular systolic and diastolic function and signs of ischemic cardiomyopathy. On coronary angiogram we analyzed severity of coronary artery disease as well as recommended treatment thereafter.
Results:
There were no significant difference in post-coronarography treatment, incidence and severity of mitral regurgitation and ischemic cardiomyopathy in alteplase vs streptokinase group- only significantly less diastolic dysfunction was noted in alteplase group (p=0.037). We noticed only significant difference when we took into consideration time from chest pain to admission at clinic. In alteplase first subgroup were more patients treated only with medications (without need for revascularization) vs streptokinase first subgroup (62,5% vs 28.6%, p=0.047). In alteplase first subgroup was lower incidence of mitral regurgitation (p =0.045), developed cardiomyopathy (p =0.009) and more preserved left ventricular diastolic function (p =0.008) compared to first streptokinase subgroup.
Conclusion:
In our study we have found a significant difference between streptokinase and alteplase in echocardiographic parameters and post-coronarography treatment when we took into consideration time from occurrence of chest pain to admission at Clinic. The best outcomes had patients who were treated with alteplase within 1.5 hour from occurrence of chest pain.
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