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[Intravenous streptokinase versus heparin in recent acute myocardial infarction. Randomized multicenter study in the
Insights
This study found that maintaining arterial patency after myocardial infarction improves heart function. Streptokinase therapy showed particular benefit for patients with anterior wall infarction.
Area of Science:
- Cardiology
- Thrombolytic Therapy
- Myocardial Infarction Management
Background:
- Acute myocardial infarction (AMI) requires prompt treatment to restore blood flow and preserve cardiac function.
- Intravenous thrombolysis with streptokinase and anticoagulation with heparin are established treatment options.
Purpose of the Study:
- To compare the efficacy of intravenous streptokinase versus conventional heparin therapy in patients with acute primary myocardial infarction.
- To assess the impact of treatment on clinical outcomes, arterial patency, and left ventricular ejection fraction.
Main Methods:
- A multicentre randomized trial involving 101 patients with AMI treated within 5 hours of symptom onset.
- Patients received either intravenous streptokinase or heparin therapy.
- Outcomes assessed included clinical status, arterial patency in the infarct zone, and ejection fraction at 3 weeks.
Main Results:
- No significant difference in mortality or arterial patency between streptokinase and heparin groups.
- Significantly higher ejection fraction in patients with patent arteries compared to occluded ones (p < 0.01).
- Streptokinase significantly improved ejection fraction in anterior wall infarction patients compared to heparin (p < 0.05).
Conclusions:
- Reestablishing arterial patency post-myocardial infarction enhances left ventricular function.
- Patients with anterior wall infarction may particularly benefit from streptokinase therapy.
Abstract:
A multicentre randomised therapeutic trial was undertaken in 8 hospitals in the Franche-Comté department of France (Belfort, Besançon, Dole, Lons-le-Saunier, Luxeuil, Montbéliard, Vesoul, Pontarlier) in which 101 patients with acute primary myocardial infarction were treated within 5 hours of onset of symptoms with either intravenous streptokinase (1,500,000 U in 30 mn) or conventional heparin therapy. The results were assessed on the clinical outcome, arterial patency in the necrosed territory and global and regional ejection fractions (EF) at the 3rd week. After randomisation, 51 patients were given heparin and 50 received streptokinase. Seven patients died in the heparin group and 4 in the streptokinase group (NS). At the third week, the artery in the necrosed zone was patent in 69% of the heparin group and in 68% of the streptokinase group (NS). The EF was significantly higher in the patients with patent arteries in the necrosed zone than in those with occluded arteries (0.49 +/- 0.12 vs 0.41 +/- 0.15, p less than 0.01). There was no significant difference in EF between the heparin and streptokinase groups. The EF was significantly higher in patients with anterior infarction who received streptokinase than in those who received heparin (0.40 +/- 0.10 vs 0.33 +/- 0.09 p less than 0.05). Segmental wall motion was significantly better at the apex and free wall. There was no significant difference between the two groups in posterior infarction. These results show that reestablishment or maintenance of arterial patency in the necrosed zone improves left ventricular function and that patients with anterior wall infarction are the ones most likely to benefit from streptokinase therapy.