The western Washington intravenous streptokinase in acute myocardial infarction randomized trial

• Published in: Circulation (New York, N.Y.) Vol. 77; no. 2; pp. 345 - 352
• Main Authors: WARD KENNEDY, J, MARTIN, G. V, DAVIS, K. B, MAYNARD, C, STADIUS, M, SHEEHAN, F. H, RITCHIE, J. L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.02.1988
• Subjects: Aged; Angiocardiography; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Clinical Trials as Topic; Female; Humans; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Pharmacology. Drug treatments; Random Allocation; Streptokinase - administration & dosage; Streptokinase - adverse effects; Washington; Human; Chemotherapy; Streptokinase; Intravenous administration; Infarct; Enzyme; Acute; Myocardium; Cardiovascular disease; Coronary heart disease; Fibrinolytic
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.77.2.345

Three hundred sixty-eight patients were randomly assigned to receive intravenous streptokinase (IVSK) (n = 191) or standard therapy (n = 177) to determine the efficacy of IVSK in the treatment of acute myocardial infarction. The mean time to treatment was 3.5 hr. At 14 days there were 12 deaths in the treatment group (6.3%) and 17 deaths in the control group (9.6%) (p = .23). Early mortality was related to infarct location. Fourteen day mortality for anterior infarctions was 10.4% for treatment with IVSK and 22.4% for control patients (p = .06) and was similar for IVSK-treated patients with inferior infarctions, 4.0% vs 1.8% (p = .32). For those randomized under 3 hr, 14 day mortality tends to be lower in treated patients, 5.2% vs 11.5% (p = .11). There was significant improvement in long-term survival for patients with anterior infarction; 2 year survival was 81% for IVSK-treated patients and 65% for control patients (p = .05). There was no improvement in survival for patients with inferior myocardial infarction (p = .27). We conclude that patients with anterior myocardial infarction have improved survival when treated within the first 6 hr of symptoms. Patients with inferior infarction do not appear to have improved survival with thrombolytic therapy. Some of this improvement in survival in patients with anterior infarction may be due to a higher frequency of revascularization procedures in the treatment group.