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High dose intravenous streptokinase in acute myocardial infarction
Insights
Intravenous streptokinase infusion (IVSK) effectively recanalized coronary arteries in 60% of acute myocardial infarction (AMI) patients. This safe treatment improved left ventricular ejection fraction in successfully treated patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombolytic Therapy
Background:
- Acute myocardial infarction (AMI) with total coronary occlusion requires prompt reperfusion.
- Early recanalization aims to limit myocardial damage and preserve left ventricular function.
- Streptokinase has been used as a thrombolytic agent in AMI.
Purpose of the Study:
- To evaluate the efficacy and safety of brief high-dose intravenous streptokinase infusion (IVSK) for early recanalization of infarct-related coronary arteries in AMI patients.
- To assess the impact of successful recanalization on left ventricular ejection fraction and patient outcomes.
Main Methods:
- 40 patients with AMI and angiographically proven total coronary occlusion received IVSK.
- Patients were divided into Group A (early recanalization) and Group B (late or no recanalization).
- Infusion rate, total dose, time to peak creatine phosphokinase (CKMB), and left ventricular ejection fraction were recorded. Follow-up included reocclusion rates and clinical outcomes.
Main Results:
- Early recanalization (48 +/- 14 min) was achieved in 24 patients (60%) with IVSK (Group A).
- Left ventricular ejection fraction improved in Group A (55% to 58%) but decreased in Group B (49% to 41%).
- No serious bleeding complications were observed; one early death from ventricular rupture in Group A and one late death from heart failure in Group B.
Conclusions:
- IVSK is an effective and safe method for early coronary recanalization in the majority of AMI patients.
- Successful early recanalization is associated with preserved or improved left ventricular function.
- IVSK offers a feasible treatment option for acute myocardial infarction with coronary thrombosis.
Abstract:
Early recanalization of infarct-related coronary arteries has been attempted in 40 patients with acute myocardial infarction (AMI) and angiographically proven total occlusion by brief high dose intravenous streptokinase infusion (IVSK). In 24 patients (60%) recanalization was achieved after 48 +/- 14 min of IVSK at an infusion rate of 30,000 to 40,000 IU/min (group A), in 16 patients there was a late (greater than 2 h) or no recanalization (group B). The total dose of SK was 1.7 +/- 0.48 Mio IU in group A and 1.74 +/- 0.41 Mio IU in group B, the time from the onset of symptoms to peak myocardial enzyme of creatine phosphokinase (CKMB) 11 +/- 3 h in group A and 22 +/- 6 h in group B (p less than 0.001). Biplane left ventricular ejection fraction increased from 55 +/- 9% at the time of acute angiography to 58 +/- 10% after 14 to 24 days in group A (p less than 0.1) and decreased from 49 +/- 11 to 41 +/- 11% in group B (p less than 0.005). There were four reocclusions in group A, two could be reopened by i.v. urokinase (1 Mio IU over 30 min). During a follow-up period of 18 +/- 8 months one patient in group A died from an early ventricular rupture 2 hours after recanalization, and one patient in group B from heart failure 7 months after IVSK. There was no serious bleeding or other complication related to IVSK. We conclude that IVSK is an effective and safe means of early recanalization of coronary thrombosis in AMI, and feasible in the majority of patients with AMI.