Abstract
Introduction: Timely fibrinolysis for acute ST-segment elevation myocardial infarction (STEMI) reduces infarct size and hence preserves LV function and reduces mortality. Optimal regimen of streptokinase (SK) infusion in such patients is a matter of interest. The current study aimed to compare efficacy and safety of accelerated SK infusion regimen in patients with STEMI versus the standard one. Methods: One hundred consecutive STEMI patients were randomly allocated into one of 2 groups: group I (50 patients) who received accelerated SK regimen (1.5 million units over 30 minutes) and group II (50 patients) received standard SK regimen (1.5 million units over 60 minutes). Efficacy was evaluated non-invasively using clinical (chest pain), ECG (resolution of ST segment) and laboratory tests (earlier and higher peaking of cardiac troponin I). Safety was evaluated by assessment of multiple in-hospital adverse events. Results: Both groups were statistically matched in all baseline criteria. There was a significant difference between both groups regarding each parameter of successful reperfusion in favor of accelerated regimen. When all these parameters were combined, 31 patients (62%) had successful reperfusion in group I versus 19 patients (38%) in group II (P = 0.016). We did not report any significant difference between both groups regarding in-hospital mortality, in-hospital heart failure, major bleeding, hypotension or allergic reaction to SK. Mean pre-discharge ejection fraction was higher in group I than group II (50.9 ± 6.6% versus 47.3 ± 4.6%, P = 0.002). Conclusion: Accelerated regimen of SK infusion is safe and effective method of reperfusion in patients with STEMI.
Highlights
Fibrinolysis for acute ST-segment elevation myocardial infarction (STEMI) reduces infarct size and preserves LV function and reduces mortality
Since morbidity and mortality due to myocardial infarction closely correlate with its size, timely reperfusion of the infarct-related artery is the mainstay of therapy to preserve left ventricular function.[2]
45% had a history of diabetes mellitus (DM), 28% were hypertensives, 59% were smokers, 7% were obese, 18% were dyslipidemic, 13% had a family history of premature coronary artery dsease (CAD), 24% had past history of diagnosed CAD and 15% had prior coronary interventions
Summary
Fibrinolysis for acute ST-segment elevation myocardial infarction (STEMI) reduces infarct size and preserves LV function and reduces mortality. The pathophysiology of ST-segment elevation myocardial infarction (STEMI) entails acute vulnerable plaque change that includes: plaque rupture, fissuring or erosion, all of which could result in total arterial occlusion if stimulus for thrombus formation is potent and collateral circulation is not well developed.[1] Since morbidity and mortality due to myocardial infarction closely correlate with its size, timely reperfusion of the infarct-related artery (either by fibrinolysis or primary percutaneous coronary intervention [PCI]) is the mainstay of therapy to preserve left ventricular function (the main predictor of survival in such cases).[2] Streptokinase (SK) is the most widely used fibrinolytic agent especially in economically burdened countries due to the higher cost of the more effective recent generations of fibrinolytics such as tissue plasminogen activator (t-PA).[3] Most randomized trials used a slow infusion of SK over 60 minutes, this may have been due to concerns regarding ensuing hypotension or hemorrhagic complications of SK with faster regimens.
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