Effect of Intravenous Streptokinase on Left Ventricular Function and Early Survival after Acute Myocardial Infarction

• Published in: The New England journal of medicine Vol. 317; no. 14; pp. 850 - 855
• Main Authors: White, Harvey D, Norris, Robin M, Brown, Michael A, Takayama, Morimasa, Maslowski, Andrew, Bass, Nigel M, Ormiston, John A, Whitlock, Toby
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 01.10.1987
• Subjects: Adrenergic beta-Antagonists - administration & dosage; Beta blockers; Biological and medical sciences; Cardiovascular system; Cineangiography; Clinical Trials as Topic; Double-Blind Method; Electrocardiography; Female; Heart attacks; Humans; Injections, Intravenous; Male; Medical sciences; Miscellaneous; Mortality; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Patients; Pharmacology. Drug treatments; Propranolol - administration & dosage; Random Allocation; Recurrence; Streptokinase - administration & dosage; Streptokinase - adverse effects; Streptokinase - pharmacology; Stroke Volume; Human; Intensive cardiocirculatory care; Chemotherapy; Streptokinase; Intravenous administration; Infarct; Enzyme; Double blind study; Myocardium; Left ventricle performance; Survival; Fibrinolytic
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198710013171402

In a double-blind trial of streptokinase for acute myocardial infarction, 219 consecutive patients presenting with infarction within four hours (mean, 3.0±0.8) of the onset of chest pain were randomly assigned to treatment with streptokinase (1.5 million units) or placebo, given intravenously over 30 minutes. The primary end point of the study was left ventricular function in patients with first infarctions. Patients who could undergo beta-blockade also received intravenous propranolol. Heparin (for 48 hours) and a combination of low-dose aspirin and dipyridamole were administered to both groups until cineangiography was performed at three weeks. In the patients with first infarctions treated with streptokinase, the left ventricular ejection fraction was 6 percentage points higher (streptokinase vs. placebo, 59±10.5 vs. 53±13.5 percent; P<0.005), with benefit to patients with either anterior infarction (57±11.9 vs. 49±15.9 percent; P<0.05) or inferior infarction (60±9.1 vs. 55±11.3 percent; P<0.05). Left ventricular function was improved regardless of whether concomitant propranolol was given. Survival (at 30 days) was improved with streptokinase: 2 deaths occurred among 79 patients who received this drug, as compared with 12 deaths among 93 patients who received placebo (2.5 vs. 12.9 percent, P = 0.012). Rates of reinfarction (streptokinase vs. placebo, 3 vs. 1 percent) and requirements for surgery or angioplasty (7 vs. 5 percent) were similar in the two groups. We conclude that administration of intravenous streptokinase (1.5 million units) to patients with a first myocardial infarction results in improved left ventricular function and short-term survival. (N Engl J Med 1987; 317: 850–5.) THROMBOLYSIS with intravenous streptokinase (1.5 million units given over one hour) has been shown to improve survival at 21 days after acute myocardial infarction, in a large drug trial (that of the Italian Group for the Study of Streptokinase in Myocardial Infarction [GISSI]). 1 The mechanism producing this benefit is presumably related to coronary-artery reperfusion with salvage of jeopardized myocardium and preservation of myocardial function. In a smaller trial (that of the Intravenous Streptokinase in Acute Myocardial Infarction Study Group [ISAM]), a nonsignificant trend toward a reduction in mortality was observed in patients treated with streptokinase. The left ventricular ejection fraction . . .