Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI–SK study

• Published in: European heart journal Vol. 23; no. 16; pp. 1282 - 1290
• Main Authors: Simoons, M.L., Krzemiñska-Pakula, M., Alonso, A., Goodman, S.G., Kali, A., Loos, U., Gosset, F., Louer, V., Bigonzi, F.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.08.2002
• Subjects: Adult; Aged; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Drug Therapy, Combination; Electrocardiography; enoxaparin; Enoxaparin - adverse effects; Enoxaparin - therapeutic use; Female; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Humans; low-molecular-weight heparin; Male; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - drug therapy; Myocardial Reperfusion - methods; Pharmacology. Drug treatments; Recurrence; streptokinase; Streptokinase - therapeutic use; Thrombolytic Therapy - methods; Treatment Outcome; Human; Drug combination; Prognosis; Infarct; Acute; Cardiovascular disease; Low molecular weight heparin; Anticoagulant; Coronary heart disease; Myocardial disease; Enoxaparin sodium; Chemotherapy; Streptokinase; Treatment; Follow up study; Myocardium; Fibrinolytic
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1053/euhj.2001.3083

Aims To establish whether the addition of enoxaparin (a low-molecular-weight heparin) to streptokinase therapy improves early and sustained coronary patency and clinical outcome in patients with evolving myocardial infarction. Methods and Results A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30mg) and subcutaneous injections (1mg.kg−1, twice daily) of enoxaparin (n=253), or placebo (n=243) for 3–8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90min and 180min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180min was observed in 36%, 44% and 19% in the enoxaparin group vs 25%, 44% and 31% in the placebo group, respectively (P=0·004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70% vs 58%, P=0·01). Combined TIMI-2 and -3 flow was also improved (88% vs 72%, P=0·001), as was TIMI frame count (P=0·003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13% vs 21%, P=0·03). Conclusion Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5–10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.