Circulation, Vol 70, 867-875, Copyright © 1984 by American Heart Association
JL Ritchie, KB Davis, DL Williams, J Caldwell and JW Kennedy
The Western Washington Intracoronary Streptokinase In Myocardial Infarction
Trial enrolled 250 patients with acute myocardial infarction. After the
coronary angiographic diagnosis of thrombosis, patients were randomly
assigned to receive either conventional therapy with heparin or
intracoronary streptokinase followed by heparin. Of the 232 patients who
survived at least 60 days, 207 (89%) underwent radionuclide
ventriculographic determination of global and regional ejection fraction at
a single institution at 62 +/- 35 days after infarction. In the first 100
patients, infarct size was also determined by quantitative single-photon
emission tomographic imaging with thallium-201 (201Tl) and expressed as a
percentage of the left ventricle with a perfusion defect. Overall, global
ejection fraction did not differ between patients treated with
streptokinase (45.9 +/- 13.9%; n = 115) and control patients (46.1 +/-
14.4%; n = 92, p = NS). Similarly, the regional posterolateral, inferior,
and anteroseptal ejection fraction did not differ between the two groups.
Infarct size as measured by 201Tl tomography was 19.4 +/- 12.8% (n = 52) of
the left ventricle for the streptokinase group and 19.6 +/- 11.8% (n = 48;
p = NS) for the control group. When patients were compared within groups by
electrocardiographic location of infarction, time to treatment, or the
presence or absence of vessel opening, there were no significant
differences between streptokinase and control patients. Statistical
inclusion of the 18 patients who died early and were unavailable for study
also failed to modify the results, except for a possible reduction in
inferior infarct size as measured by 201Tl tomography.(ABSTRACT TRUNCATED
AT 250 WORDS)
ARTICLES
Global and regional left ventricular function and tomographic radionuclide perfusion: the Western Washington Intracoronary Streptokinase In Myocardial Infarction Trial
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