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Treatment of acute myocardial infarction with anisoylated plasminogen streptokinase activator complex
Insights
Anisoylated plasminogen streptokinase activator complex (APSAC) reduced infarct size in patients with myocardial infarction, particularly when administered early. This treatment showed improved outcomes and is suitable for district hospitals.
Area of Science:
- Cardiology
- Thrombolytic Therapy
Background:
- Myocardial infarction (MI) remains a leading cause of mortality.
- Early reperfusion therapy is crucial for limiting infarct size and improving patient outcomes.
- Streptokinase and tissue plasminogen activator are established thrombolytic agents, but their administration can be complex.
Purpose of the Study:
- To evaluate the efficacy of anisoylated plasminogen streptokinase activator complex (APSAC) in reducing infarct size in patients with acute myocardial infarction.
- To assess the impact of APSAC administration timing on treatment effectiveness.
- To determine the safety and clinical outcomes associated with APSAC use in a district hospital setting.
Main Methods:
- A controlled trial involving 149 patients with probable myocardial infarction.
- Patients were prospectively assigned to receive either APSAC or standard care (control).
- Entry into the trial was categorized as early (within 2.5 hours) or late (2.5-4 hours) after symptom onset.
Main Results:
- APSAC administration resulted in a significant reduction in myocardial creatine kinase isoenzyme activity, indicating smaller infarct size, predominantly in the early entry group.
- Patients receiving APSAC experienced more early ventricular arrhythmias, suggestive of reperfusion, and greater preservation of R waves.
- While minor adverse effects were more common in the APSAC group (26% vs 3%), the 9-12 month follow-up showed a lower mortality rate (7 deaths vs 12 deaths in the control group).
Conclusions:
- APSAC is an effective thrombolytic agent for acute myocardial infarction, with benefits most pronounced when administered early.
- The ease of administration and demonstrated efficacy suggest APSAC is a suitable treatment option for suspected acute myocardial infarction in district hospitals.
- APSAC therapy appears to improve clinical outcomes and reduce mortality in the medium term.
Abstract:
A controlled trial in 149 patients admitted to a district hospital with probable myocardial infarction tested the effect of 30 units of anisoylated plasminogen streptokinase activator complex (APSAC) on indices of infarct size. Patients were grouped prospectively according to whether they entered the trial within two and a half hours (early entry) or between two and a half and four hours (late entry) after onset of the symptoms. Sixty seven of 73 patients in the control group showed increased plasma activity of myocardial creatine kinase isoenzyme that was diagnostic of infarction compared with only 60 of 76 who received APSAC. The difference was significant overall but occurred predominantly in the early entry group. The patients who received APSAC had more early ventricular arrhythmias, compatible with reperfusion, and showed greater preservation of R waves during admission to hospital. Unwanted effects were generally minor and more common in the actively managed group than the control group (26% v 3%). After nine to 12 months of follow up 12 patients in the control group had died compared with seven in the actively managed group. The ease of administration and the apparent efficacy of APSAC suggest that it is suitable for use in a district hospital for patients with suspected acute myocardial infarction.