Prospective randomized trial of intravenous and intracoronary streptokinase in acute myocardial infarction.
- 1 November 1983
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 68 (5), 1051-1061
- https://doi.org/10.1161/01.cir.68.5.1051
Abstract
To evaluate the relative thrombolytic efficacy and complications of intracoronary vs high-dose, short-term intravenous streptokinase infusion in patients with acute myocardial infarction, we performed baseline coronary arteriography and then randomly allocated 51 patients with acute myocardial infarction to receive either intracoronary (n = 25) or intravenous (n = 26) streptokinase. Patients getting the drug by the intracoronary route received 240,000 IU of streptokinase into the infarct-related artery over 1 hr, whereas those getting the drug by the intravenous route received either 500,000 IU of streptokinase over 15 min (n = 10) or 1 million IU of streptokinase over 45 min (n = 16). Angiographically observed thrombolysis occurred in 76% (19/25) of the patients receiving intracoronary streptokinase, in 10% (1/10) of the patients receiving 500,000 IU of streptokinase intravenously, and in 44% (7/16) of the patients receiving 1 million IU of streptokinase intravenously. Among patients in whom thrombolysis was observed, mean elapsed time from onset of streptokinase infusion until lysis was 31 +/- 18 min in patients receiving intracoronary streptokinase and 38 +/- 20 min in those receiving intravenous streptokinase (p = NS). Among patients in whom intravenous streptokinase "failed," intracoronary streptokinase in combination with intracoronary guidewire manipulation recanalized only 7% (1/15). Fibrinogen levels within 6 hr after streptokinase were significantly lower in the patients receiving intravenous streptokinase (39 +/- 17 mg/dl) than the levels in those receiving intracoronary streptokinase (88 +/- 70 mg/dl) (p less than .05) but were similar 24 hr after streptokinase in the two groups. Bleeding requiring transfusion occurred in one patient in each group. Thus, in this prospective randomized trial of intracoronary vs intravenous streptokinase, hemorrhagic complications were few, although both regimens produced a systemic lytic state. Although the thrombolytic efficacy of intracoronary streptokinase was superior to that of high-dose, short-term intravenous streptokinase, the higher-dose intravenous regimen (1 million IU over 45 min) achieved thrombolysis in a significant minority (44%) of patients and might be useful therapy for patients not having access to emergency catheterization.Keywords
This publication has 16 references indexed in Scilit:
- Effect of Intravenous Streptokinase on Acute Myocardial InfarctionNew England Journal of Medicine, 1982
- High-dose, brief intravenous streptokinase early in acute myocardial infarctionAmerican Heart Journal, 1982
- Treatment of myocardial infarction with intracoronary streptokinase: Efficacy and safety data from 209 United States cases in the Hoechst-Roussel registryAmerican Heart Journal, 1982
- Practical Proposal for Lowering Mortality from Acute Myocardial InfarctionNew England Journal of Medicine, 1982
- Quantitative axial oblique contrast left ventriculography: Validation of the method by demonstrating improved visualization of regional wall motion and mitral valve function with accurate volume determinationsAmerican Heart Journal, 1982
- Efficacy of percutaneous transluminal coronary recanalization utilizing streptokinase thrombolysis in patients with acute myocardial infarctionAmerican Heart Journal, 1981
- Effects of intracoronary streptokinase in acute myocardial infarctionAmerican Heart Journal, 1981
- Streptokinase in Acute Myocardial InfarctionNew England Journal of Medicine, 1979
- Left heart catheterization and angiography via the percutaneous femoral approach using an arterial sheathCatheterization and Cardiovascular Diagnosis, 1979
- StreptokinaseDrugs, 1973