Streptokinase in Acute Myocardial Infarction — Benefits and Risks
Thirty years ago in 1958 the first experience with intravenous administration of fibrinolytic agents in 22 patients with acute myocardial infarction was reported by Fletcher and coworkers in the United States . The next step was intermittent diastolic administration of fibrinolysin through a catheter in Valsalva’s sinus in 1960, reported by Boucek and Murphy . In the period between 1960 and 1966 uncontrolled and controlled studies were reported, involving intravenous administration of streptokinase with initial dose of 250×103 U followed by maintenance doses of 100×103 U/h for periods of 12–24 h in patients with acute myocardial infarction. As a result, successful treatment by thrombolysis or fibrinolysis was suspected but not proven in individual cases. Although all investigators recognized the necessity of coronary angiography, prevailing opinion at that time held that angiography in the setting of acute infarction was associated with unacceptably high risk. Randomized and controlled multicenter studies with large groups of patients were initiated to allow statistical analysis of mortality in this situation.
KeywordsCatheter Ischemia Heparin Cardiol Plasminogen
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- 2.Braunwald E (1983) Thrombolytic therapy in patients with acute myocardial infarction. Summary and comments. Circulation 68 [Suppl 1]: 67–69Google Scholar
- 3.Chazov EJ, Matveeva LS, Mazaev AV, Ruda MY (1975) Intracoronary administration of fibrolysin in myocardial infarction. Therapy-Archiv Kardiolog. Fragen 48: 7Google Scholar
- 6.Fletcher AP, Alkjaersig N, Smyrniotis FE, Sherry S (1958) The treatment of patients suffering from early myocardial infarction by massive and prolonged streptokinase therapy. Tr Assoc Am Physicians 71: 287Google Scholar
- 8.Miller HI, Almagor J, Keren G, Chernilas J, Roth A, Eschar Y, Shapira I, Shagorodsky B, Berenfeld D, Laniado S (1987) Early intervention in acute myocardial infarction: significance for myocardial salvage of immediate intravenous streptokinase therapy followed by coronary angioplasty. J Am Coll Cardiol 9 : 608–614PubMedCrossRefGoogle Scholar
- 12.Rutsch W, Schartl M, Schmutzler H (1986) Percutaneous transluminal angioplasty in acute myocardial infarction with and without prior systemic fibrinolytic therapy. In: Höfling B (ed) Current problems in PTCA. Steinkopff, DarmstadtGoogle Scholar
- 19.The TIMI Study Group (1985) Special report. The thrombolysis in myocardial infarction (TIMI) trial. N Engl J Med: 932–936Google Scholar
- 21.Tognoni F, Rovelli F et al. for GISSI (Gruppo Italiano per lo Studio della streptochinasi nell’infarcto myocardio) (1986) Effectiveness of intravenous thrombolytic therapy in acute myocardial infarction. Lancet I: 397–402Google Scholar
- 22.Topoi EJ, Morris DC, Smalling RW, Schumacher RR, Taylor CR, Nishikawa A, Liberman HA, Collen D, Tufte ME, Grossbard EB, O’Neill WW (1987) A multicenter, randomized, placebo-controlled trial of a new form of intravenous recombinant tissue-plasminogen activator (activase) in acute myocardial infarction. J Am Coll Cardiol 9: 1205–1213CrossRefGoogle Scholar
- 23.Topol EJ, Califf RM, George BS, Kereiakes DJ, Abbottsmith CW, Candela RJ, Lee KL, Pitt B, Stack RS, O’Neill WW (1987) A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med 10 : 581–588CrossRefGoogle Scholar
- 25.Verstraete M, Arnold AER, Brower RW, Collen D, de Bono DP, de Zwaan C, Erbel R, Hillis WS, Lennane RJ, Lubsen J, Mathey D, Reid DS, Rutsch W, Schartl M, Schofer J, Serruys PW, Simoons ML, Uebis R, Vahanian A, Verheugt FA, von Essen R (1987) Acute coronary thrombolysis with recombinant human tissue-type plasminogen activator: initial patency and influence of maintained infusion on reocclusion rate. Arti J Cardiol 60: 231–237CrossRefGoogle Scholar