Effects of streptokinase during acute myocardial infarction on the signal-averaged electrocardiogram and on the frequency of late arrhythmias

• Published in: The American journal of cardiology Vol. 72; no. 9; pp. 647 - 651
• Main Authors: Tobé, Tom J.M., de Langen, Cees D.J., Crijns, Harry J.G.M., Wiesfeld, Ans C.P., van Gilst, Wiek H., Faber, Karin G., Lie, Kong I., Wesseling, Harry
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.09.1993; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - prevention & control; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Cardiac arrhythmia; Cardiovascular disease; Death, Sudden, Cardiac - etiology; Drug therapy; Electrocardiography - drug effects; Electrocardiography - methods; Female; Follow-Up Studies; Humans; Male; Medical research; Medical sciences; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Pharmacology. Drug treatments; Recurrence; Streptokinase - therapeutic use; Survival Rate; Tachycardia, Ventricular - etiology; Thrombolytic Therapy; Ventricular Fibrillation - etiology; Human; Prognosis; Infarct; Retarded potential; Cardiovascular disease; Exploration; Coronary heart disease; Electrodiagnosis; Chemotherapy; Streptokinase; Treatment; Electrocardiography; Myocardium; Fibrinolytic
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(93)90878-G

Although a number of studies have shown that the incidence of late potentials is lower after thrombolytic therapy, it is not known whether this is paralleled by fewer arrhythmic events during long-term follow-up. In patients with first acute myocardial infarction, filtered QRS duration was significantly shorter when treated with streptokinase (95 ± 11 ms, n = 53) than when treated with conventional therapy (99 ± 12 ms, n = 77, p < 0.05). The low-amplitude signal (D 40) was shorter after thrombolysis (28 ± 11 vs 33 ± 12 ms, p < 0.02). Terminal root-mean-square voltage did not differ significantly (41 ± 24 vs 35 ± 23 μV). Irrespective of treatment, late potentials were predictive in the complete group (n = 171) for arrhythmic events during follow-up (13 ± 6 months, range 6 to 24) (hazard ratio 7.7, p < 0.02, Cox proportional-hazards survival analysis), but treatment (streptokinase vs conventional) did not significantly affect outcome when added to the model. It is concluded that thrombolysis prevents the development of late potentials. However, this study does not confirm the hypothesis that prevention of late potentials leads to a decrease in arrhythmic events.