Early beneficial effect of streptokinase on left ventricular function in acute myocardial infarction

Abstract

The effect of intravenous streptokinase therapy on the time course of functional recovery was investigated in a controlled study of 64 patients randomized within 3 hours after the onset of acute myocardial infarction (AMI). Contrast ventriculography was performed 1 to 4 days after AMI and repeated 5 weeks later. Wall motion was analyzed by the centerline method in the central infarct, peripheral infarct and noninfarct regions. In patients with ventriculographic data at the early catheterization, streptokinase-treated patients had less severe hypokinesia in the central infarct region than control patients (−2.9 ± 0.9 [n = 29] vs −3.4 ± 0.7 standard deviations below normal [n = 21], p < 0.05). The benefit of streptokinase was more marked in the peripheral infarct region (-1.5 ± 0.7 vs −2.1 ± 0.6, p < 0.001). As a result, the ejection fraction was slightly higher in treated versus control groups (46 ± 10 vs 43 ± 7%, respectively; difference not significant). At 5 weeks, function in the streptokinase and control groups had diverged further because of continued improvement in the streptokinase-treated patients. This study shows that streptokinase benefits left ventricular (LV) function by 1 to 4 days after AMI, earlier than previously reported. The benefit was not limited to the peripheral infarct region, where ischemia might have been less severe, but Was also seen in the central infarct region. The implication is that thrombolytic therapy can improve LV function during the period of myocardial stunning, while myocardial function is still recovering.