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Intravenous streptokinase during acute myocardial infarction. A prospective open study
F Stammen1, F Van de Werf, J Vanhaecke
1Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Insights
Intravenous streptokinase effectively dissolves clots in acute myocardial infarction (AMI) when given within 6 hours. However, it showed limited impact on overall left ventricular function, necessitating further patient evaluation.
Area of Science:
- Cardiology
- Thrombolytic Therapy
- Acute Myocardial Infarction
Background:
- Acute myocardial infarction (AMI) remains a leading cause of mortality.
- Timely reperfusion therapy is critical for improving outcomes in AMI.
- Streptokinase is a widely used thrombolytic agent, but its efficacy within specific time windows requires evaluation.
Purpose of the Study:
- To assess the effectiveness of intravenous streptokinase in patients with acute myocardial infarction.
- To evaluate the impact of streptokinase on infarct-related vessel patency and left ventricular function.
- To determine the necessity of pre-discharge evaluations for residual ischemia.
Main Methods:
- 108 patients with AMI received high-dose (1.5 million units) streptokinase infusion within 6 hours of symptom onset.
- Anticoagulation followed the infusion.
- Submaximal exercise testing and coronary arteriography were performed in 100 survivors before discharge.
Main Results:
- 67 patients achieved a patent infarct-related vessel.
- Clinical reocclusion occurred in 21 patients.
- Left ventricular function showed no significant difference between patients with patent and non-patent vessels (ejection fraction 59.5% vs. 57.4%).
- 20 patients underwent further procedures, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG).
Conclusions:
- Intravenous streptokinase is a potent thrombolytic agent for AMI when administered within a 6-hour window.
- The treatment had a limited effect on global left ventricular function.
- Pre-discharge evaluation is essential to identify patients with residual ischemia requiring further intervention.
Abstract:
To evaluate the efficacy of intravenous streptokinase in acute myocardial infarction (AMI) 108 patients received a high-dose (1.5 million units), short-term infusion (60 minutes) within 6 hours after onset of symptoms, followed by anticoagulation. Before discharge a submaximal exercise test and a coronary arteriography were performed in 100 surviving patients. Sixty-seven patients had a patent infarct-related vessel. Clinical reocclusion occurred in 21 patients. Left ventricular function was slightly, but not significantly, better in patients with patent infarct-related vessels: ejection fraction 59.5 +/- 13% versus 57.4 +/- 13%. Additional procedures were performed in 20 patients: percutaneous transluminal coronary angioplasty (PTCA) in 8 and coronary artery bypass surgery (CABG) in 12. The results indicate that streptokinase applicated during a 6 hour-time window is a potent thrombolytic agent in acute myocardial infarction with limited effect on global left ventricular function. Pre-discharge evaluation is necessary to screen patients for residual ischemia.