Related Experiment Videos
Thrombolysis and myocardial infarction
Insights
Intravenous streptokinase (SK) significantly reduces in-hospital mortality for acute myocardial infarction (AMI) patients, especially when given within one hour of symptom onset. Long-term benefits were sustained, with low adverse reactions observed.
Area of Science:
- Cardiology
- Thrombolytic Therapy
Background:
- Acute myocardial infarction (AMI) is often caused by coronary thrombus.
- Streptokinase (SK) is a thrombolytic agent studied for AMI treatment.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous streptokinase (SK) in patients with acute myocardial infarction (AMI).
Main Methods:
- A large-scale randomized trial (GISSI) involving 11,712 AMI patients.
- Administration of 1.5 million units of SK via intravenous infusion.
- Analysis of in-hospital mortality, adverse reactions, 12-month follow-up, plasma creatine kinase (CK) levels, and reinfarction rates.
Main Results:
- Intravenous SK reduced in-hospital mortality from 13% to 10.7% (P = 0.0002).
- Mortality reduction reached 47% in patients treated within 1 hour.
- Beneficial effects on mortality persisted at 12 months; adverse reactions were low (4.7%).
- Increased plasma creatine kinase (CK) levels observed in SK-treated patients.
- Higher reinfarction rates noted in the SK group (7.4% vs. 4.4%).
Conclusions:
- Intravenous streptokinase (SK) is effective in reducing mortality for acute myocardial infarction (AMI) patients.
- Early treatment with SK yields the greatest mortality benefit.
- Further research is needed for post-thrombolytic and residual stenosis management.
Abstract:
Many studies suggested that the administration of streptokinase (SK) via a coronary catheter or with intravenous treatment is effective in lysing the offending thrombus which is the cause of most acute myocardial infarctions (AMI). The research carried out by the Italian Group for the Study of Streptokinase in Infarct (GISSI) which enrolled a central randomised population of 11,712 patients with AMI, clearly suggests: intravenous infusion of 1.5 million units of SK reduces in-hospital mortality from 13% to 10.7% (P = 0.0002); the decrease in mortality is 47% in patients treated within 1 hour after the onset of pain. The incidence of adverse reaction was low (4.7%). The results of the follow-up (12 months) demonstrate that beneficial effects of SK treatment on mortality were unchanged. Analysis of plasma creatine kinase curves (CK) from 7,632 patients demonstrates that the rate of input and disappearance of CK into the blood was significantly increased in SK patients. In elderly patients (greater than 65 years) the in-hospital mortality was higher (22.4% vs. 7.4%): SK is effective in patients with first AMI (19.1% vs. 22.9%). The incidence of reinfarction in the hospital phase and at the six months follow-up is higher in SK group (7.4% vs. 4.4%). Some questions remain open about the therapeutical approach to the post-thrombolytic phase and about the treatment of residual stenosis.