A randomized controlled trial of intravenous streptokinase in evolving acute myocardial infarction

Olson, Harold G.; Butman, Samuel M.; Piters, Kenneth M.; Gardin, J. M.; Lyons, Kenneth P.; Jones, Laybon; Chilazi, George; Kumar, Kanwal; Colombo, Antonio

doi:10.1016/0002-8703(86)90001-3

Cited by 34 publications

(8 citation statements)

References 44 publications

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“…Our results are confirmed by those of Olson [5] and Schreiber [7], Studies carried out using early follow-up angiogra phy, usually 1 h after treatment, estimate the effectiveness of intravenous thrombolysis to be 55% [1], a figure which is greatly superior to that achieved with conventional treatment [1]. The results on left ventricular function will be the subject of further papers.…”

Section: Efficacity O F Intravenous Thrombolysis On Coronary Obstructionsupporting

confidence: 86%

Intravenous Streptokinase versus Heparin in the Acute Stage of Myocardial Infarction

Sainsous¹,

Bonnet²,

Serradimigni³

1986

Pathophysiol Haemos Thromb

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Section: Efficacity O F Intravenous Thrombolysis On Coronary Obstructionsupporting

confidence: 86%

Intravenous Streptokinase versus Heparin in the Acute Stage of Myocardial Infarction

Sainsous¹,

Bonnet²,

Serradimigni³

1986

Pathophysiol Haemos Thromb

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“…Haemoptysis 2(0-6) 4(1-1) Epistaxis 1 (0-3) 4 (1-1) Oropharyngeal bleeding 7 (2-0) Pericardial bleeding 6 (1-6) Genital bleeding 2 (0-6) Localhaematoma 9 (2)(3)(4)(5) 68 (19) Prolonged bleeding 2 (0-6) 15 (4-2) Unexplained anaemia 3 t207 Patients allocated to receive placebo, 179 patients allocated to receive recombinant plasminogen activator.…”

Section: Resultsmentioning

confidence: 99%

Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction.

Werf

Arnold²

1988

BMJ

375

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Study objective-To assess effect of intravenous recombinant tissue type plasminogen activator on size of infarct, left ventricular function, and survival in acute myocardial infarction.Design-Double blind, randomised, placebo controlled prospective trial of patients with acute myocardial infarction within five hours after onset of symptoms.Setting-Twenty six referral centres participating in European cooperative study for recombinant tissue type plasminogen activator.Patients-Treatment group of 355 patients with acute myocardial infarction allocated to receive intravenous recombinant plasminogen activator. Controls comprised 366 similar patients allocated to receive placebo.Intervention-All patients were given aspirin 250 mg and bolus injection of 5000 IU heparin immediately before start of trial. Patients in treatment group were given 100 mg recombinant tissue plasminogen activator over three hours (10 mg intravenous bolus, 50 mg during one hour, and 40 mg during next two hours) by infusion. Controls were given placebo by same method. Full anticoagulation treatment and aspirin were given to both groups until angiography (10-22 days after admission). P3 Blockers were given at discharge.End point-Left ventricular function at 10-22 days, enzymatic infarct size, clinical course, and survival to three month follow up.Measurements and main results -Mortality was reduced by 51% (95% confidence interval -76 to 1) in treated patients at 14 days after start of treatment and by 36% (-63 to 13) at three months. For treatment within three hours after myocardial infarction mortality was reduced by 82% (-95 to -31) at 14 days and by 59% (-83 to -2) at three months. During 14 days in hospital incidence of cardiac complications was lower in treated patients than controls (cardiogenic shock, 2 5% v 6-0%; ventricular fibrillation, 3-4% v 6-3%; and pericarditis, 6-2% v 11-0% respectively), but that of angioplasty or artery bypass, or both was higher (15-8% v 9 6%) during the first three months. Bleeding complications were commoner in treated than untreated patients. Most were minor, but 1-4% of treated patients had intracranial haemorrhage within three days after start of infusion.Enzymatic size of infarct, determined by ca hydroxybutyrate dehydrogenase concentrations, was less (20%, 2p=0-0018) in treated patients than in controls. Left ventricular ejection fraction was 2-2% higher (0-3 to 4.0) and end diastolic and end systolic volumes smaller by 6 0 ml (-0-2 to -11-9) and 5 8 ml (-0.9 to -10-6), respectively, in treated patients.Conclusion-Recombinant tissue type plasminogen activator with heparin and aspirin reduces size of infarct, preserves left ventricular function, and reduces complications and death from cardiac causes but at increased risk of bleeding complications.

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“…The practical concept which emerges from the above discussion is that the maintenance or long-term restoration of patency of the infarct-related artery, either spontaneous or obtained by the administration of streptoki nase, limits myocardial damage following in farction, a concept already previously de scribed [7,14,16,17,23,24], Under such conditions, it would now seem possible to evaluate results very early after the end of thrombolytic treatment, within a period of not more than 48-72 h. This attitude should provide more accurate evaluation about the degree of arterial patency and, above all, make it possible to carry out revasculariza tion by either angioplasty or aortocoronary bypass of arteries accessible to either of these techniques. This should make it possible to limit the number of secondary reocclusions, estimated in the literature to be between 20 and 30% of cases [10].…”

Section: Discussionmentioning

confidence: 97%

Intravenous Streptokinase versus Heparin in Recent Acute Myocardial Infarction

Bassand¹,

Faivre²,

Becque³

et al. 1986

Pathophysiol Haemos Thromb

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A randomized controlled trial of intravenous streptokinase in evolving acute myocardial infarction

Cited by 34 publications

References 44 publications

Intravenous Streptokinase versus Heparin in the Acute Stage of Myocardial Infarction

Intravenous Streptokinase versus Heparin in the Acute Stage of Myocardial Infarction

Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction.

Intravenous Streptokinase versus Heparin in Recent Acute Myocardial Infarction

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