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Streptokinase infusion significantly reduced six-month mortality in acute myocardial infarction patients. This treatment was well-tolerated, with minor bleeding complications, making it a viable option for medium-risk cardiac patients.
Area of Science:
- Cardiology
- Thrombolytic Therapy
Background:
- Acute myocardial infarction (AMI) poses a significant mortality risk.
- Early intervention with thrombolytic agents is crucial for improving outcomes in AMI.
Purpose of the Study:
- To evaluate the efficacy and safety of streptokinase in reducing mortality in patients with acute myocardial infarction.
- To assess the impact of streptokinase on medium-risk and high-risk AMI patients admitted within 12 hours of symptom onset.
Main Methods:
- A controlled trial involving 315 medium-risk and high-risk patients across 11 European centers.
- Patients were randomized to receive either a 24-hour infusion of streptokinase or glucose (control).
- Clinical severity was stratified, and outcomes were assessed at six months.
Main Results:
- Overall six-month mortality was significantly lower in the streptokinase group (15.6%) compared to the control group (30.6%) (P < 0.01).
- Bleeding complications were more frequent with streptokinase but generally clinically unimportant, with two nonfatal cerebral hemorrhages.
- The treatment was well-tolerated by the majority of patients.
Conclusions:
- Streptokinase administration, as used in this trial for medium-risk patients in coronary-care units within 12 hours of symptom onset, effectively reduces six-month mortality.
- The benefits of streptokinase in reducing AMI mortality outweigh the risks of minor bleeding complications.
Abstract:
In a controlled trial of streptokinase in acute myocardial infarction, 512 of 2338 patients at 11 European centers were stratified according to clinical severity. Three hundred fifteen patients allocated to medium-risk and high-risk groups were randomized to a 24-hour infusion of streptokinase or glucose. There were no essential differences in the severity of illness in the two groups before infusion. The overall mortality rates within six months were significantly lower (P less than 0.01) in the streptokinase group (15.6 per cent) than in the control group (30.6 per cent). Bleeding complications were more frequent in the streptokinase group; except for two nonfatal cerebral hemorrhages these complications were clinically unimportant. The treatment was generally well tolerated. We tolerated. We conclude that streptokinase given under the conditions of this trial -- to medium-risk patients admitted to a coronary-care unit within 12 hours of onset of symptoms -- reduces mortality at six months. (N Engl J Med 301:797-802, 1979)