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Streptokinase in recent myocardial infarction: a controlled multicentre trial. European working party
Insights
In patients with recent myocardial infarction, streptokinase significantly reduced hospital mortality and reinfarction rates compared to heparin. This study highlights streptokinase
Area of Science:
- Cardiology
- Pharmacology
Background:
- Myocardial infarction (MI) is a leading cause of mortality.
- Early treatment aims to restore blood flow and reduce infarct size.
- The efficacy of thrombolytic agents versus anticoagulants in acute MI requires ongoing investigation.
Purpose of the Study:
- To compare the efficacy of streptokinase and heparin in reducing mortality and reinfarction in patients with acute myocardial infarction.
- To assess the safety profiles of both treatment regimens.
Main Methods:
- A controlled multicentre trial randomized 764 patients with MI (duration < 24 hours) to receive either streptokinase or heparin for 24 hours.
- Standardized treatment protocols were followed.
- Patient data were analyzed retrospectively, with chart exclusions for data failures.
Main Results:
- Total hospital mortality was lower in the streptokinase group (18.5%) compared to the heparin group (26.3%).
- Mortality after 24-hour infusion was significantly lower with streptokinase (10.6%) versus heparin (17.8%) (P=0.011).
- Reinfarction rates were significantly lower in patients treated with streptokinase (P=0.036), though bleeding and pyrexia were more frequent.
Conclusions:
- Streptokinase demonstrated superiority over heparin in reducing mortality and reinfarction rates in patients with recent myocardial infarction.
- The findings support the use of streptokinase for acute MI, with careful monitoring for adverse events like bleeding and fever.
Abstract:
In this controlled multicentre trial treatment with either streptokinase or heparin was allocated at random to patients suffering from myocardial infarction of less than 24 hours' duration. Treatment with either drug was standardized and lasted for 24 hours. A total of 764 patients entered the trial; 34 patient charts were rejected (including all 28 charts from one centre) because of data failure. On retrospective analysis of the 730 remaining patients the two groups were found to have been comparable at the start.The total hospital mortality was 18.5% of 373 patients allotted to streptokinase treatment and 26.3% of 357 given herapin. The mortality after infusion (24 hours) was 10.6% of 340 patients treated with streptokinase and 17.8% of 320 given herapin (P=0.011). Reinfarction in hospital after the 24-hour period of infusion occurred significantly less often in patients treated with streptokinase (P=0.036). Bleeding from puncture sites and pyrexia occurred more frequently during streptokinase treatment.After exclusion of those patients whose diagnosis was unconfirmed on retrospective assessment, the total hospital mortality rate was 19.0% of 357 patients treated with streptokinase and 27.4% of 339 treated with heparin (P=0.011). These results indicate that in recent myocardial infarction streptokinase was superior to heparin in reducing mortality and reinfarction rate during an average period of six weeks in hospital.