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Intracoronary versus intravenous streptokinase in acute myocardial infarction
1Department of Cardiology, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Insights
Intracoronary streptokinase is more effective for acute myocardial infarction treatment than intravenous administration. This method achieved significantly higher recanalization rates in patients with coronary artery blockages.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Acute myocardial infarction (AMI) necessitates rapid restoration of coronary blood flow.
- Thrombolytic therapy is a cornerstone in managing AMI.
- Streptokinase is a commonly used thrombolytic agent, administered via intravenous or intracoronary routes.
Purpose of the Study:
- To compare the efficacy of intracoronary versus intravenous streptokinase in achieving coronary recanalization.
- To evaluate the success rate of thrombolysis in patients with acute myocardial infarction.
Main Methods:
- A randomized trial involving 32 patients with AMI.
- Patients received either intracoronary (n=17) or intravenous (n=15) streptokinase within 4 hours of symptom onset.
- Coronary arteriography was performed before and after treatment to assess recanalization.
Main Results:
- Intracoronary streptokinase achieved a recanalization rate of 71.4% (10/14) compared to 25% (3/12) with intravenous administration (P<0.05).
- Spontaneous thrombolysis rates were similar between groups (17.6% intracoronary vs. 20% intravenous).
- Both methods demonstrated a low incidence of bleeding complications.
Conclusions:
- Intracoronary streptokinase administration is significantly more effective than intravenous administration for achieving coronary recanalization in acute myocardial infarction.
- The findings support the use of intracoronary streptokinase when baseline coronary arteriography is feasible for AMI treatment.
- Further research may explore optimal dosing and timing for intracoronary thrombolysis.
Abstract:
To assess the relative efficacy of coronary thrombolysis using intracoronary versus intravenous streptokinase, 32 patients with acute myocardial infarction were randomly assigned to receive intracoronary (n = 17) and intravenous streptokinase (n = 15). All patients underwent selective coronary arteriography before and after administration of streptokinase by either route within 4 hours of the onset of symptoms. Intravenous streptokinase was given as 750,000 units over 30 minutes, while a mean dose of 180,000 units was required for thrombolysis in the group having intracoronary delivery. Recanalization occurred in 71.4% (10 of 14) of patients receiving streptokinase, by the intracoronary group in contrast to only 25% of patients (3 of 12) who received the drug intravenously (P less than 0.05). Spontaneous thrombolysis was seen in 17.6% and 20% of the patients in the groups having intracoronary and intravenous delivery, respectively. Bleeding complications were few in both groups. Thus, when baseline coronary arteriography is performed, recanalization with intracoronary streptokinase is more effective in the treatment of acute myocardial infarction than intravenous streptokinase.