Circulation, Vol 86, 1710-1717, Copyright © 1992 by American Heart Association
WW O'Neill, R Weintraub, CL Grines, TB Meany, BR Brodie, HZ Friedman, RG Ramos, V Gangadharan, RN Levin and N Choksi
BACKGROUND. The value of routine administration of intravenous thrombolytic
agents during percutaneous transluminal coronary angioplasty (PTCA) therapy
of acute myocardial infarction (MI) has not been determined. Therefore, we
prospectively randomized 122 patients with evolving MI to PTCA therapy with
or without adjunctive intravenous streptokinase therapy. METHODS AND
RESULTS. Patients with ECG ST segment elevation who presented within 4
hours of symptom onset, had no contraindication to thrombolytic therapy,
and were not in cardiogenic shock were enrolled. They were treated
immediately with intravenous heparin (10,000 units) and oral aspirin (325
mg) and randomized to treatment with placebo or streptokinase (1.5 M units)
administered intravenously over 30 minutes. Patients then were taken
immediately to the catheterization laboratory, and those with suitable
coronary anatomy underwent immediate PTCA. Subsequent clinical course,
serial radionuclide ventriculography, and 6-month repeat angiography were
analyzed. A total of 106 patients were treated with PTCA. Use of PTCA was
similar for placebo (92%) and streptokinase (83%) groups. Angioplasty was
successful in 95% of patients, with no difference in placebo (93%) and
streptokinase (98%) groups. Serial radionuclide ventriculography
demonstrated no difference in 24-hour (52 +/- 12% versus 50 +/- 12%) or
6-week (51 +/- 12% versus 51 +/- 13%) ejection fraction values for placebo
and streptokinase groups, respectively. Contrast ventriculography
demonstrated improvement in immediate (54 +/- 12%) versus 6-month (60 +/-
15%, p < 0.05) values for the overall group. No differences in 6-month
values were present (58 +/- 15% versus 62 +/- 15%, p = NS) for placebo and
streptokinase groups, respectively. Coronary angiography was performed in
75% of the 90 patients eligible for restudy. Arterial patency was 87% at 6
months, and coronary restenosis was present in 38% of patients. No
differences in chronic patency or restenosis were detected for the two
treatment groups. Although adjunctive intravenous streptokinase therapy did
not improve outcome, it did complicate the hospital course. Hospitalization
was longer (9.3 +/- 5.0 versus 7.7 +/- 4.4 days, p = 0.046) and more costly
($25,191 +/- 15,368 versus $19,643 +/- 7,250, p < 0.02). Transfusion
rate was higher (39% versus 8%, p = 0.0001) and need for emergency coronary
bypass surgery was greater (10.3% versus 1.6%, p = 0.03) for the
streptokinase-treated patients. CONCLUSIONS. Adjunctive intravenous
streptokinase therapy does not enhance early preservation of ventricular
function, improve arterial patency rates, or lower restenosis rates after
PTCA therapy of acute MI. Hospital course is longer, more expensive, and
more complicated. For these reasons, PTCA therapy of acute MI should not be
routinely performed with adjunctive intravenous streptokinase therapy.
ARTICLES
A prospective, placebo-controlled, randomized trial of intravenous streptokinase and angioplasty versus lone angioplasty therapy of acute myocardial infarction
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Mich. 48073.
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|
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|
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|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
E. C. Keeley and W. D. Weaver Combination therapy for acute myocardial infarction J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1963 - 1965. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 S. M. Lanzkron and W. R. Bell State-of-the-Art Review : Management of Patients Who Require Invasive Procedures Immediately Following Thrombolytic Therapy Clinical and Applied Thrombosis/Hemostasis, July 1, 1996; 2(3): 158 - 163. [Abstract] [PDF]
|
|
|
|
|
|
C. Landau, R. A. Lange, and L. D. Hillis Percutaneous Transluminal Coronary Angioplasty N. Engl. J. Med., April 7, 1994; 330(14): 981 - 993. [Full Text]
|
|
|
|
|
|
C. L. Grines, K. F. Browne, J. Marco, D. Rothbaum, G. W. Stone, J. O'Keefe, P. Overlie, B. Donohue, N. Chelliah, G. C. Timmis, et al. A Comparison of Immediate Angioplasty with Thrombolytic Therapy for Acute Myocardial Infarction N. Engl. J. Med., March 11, 1993; 328(10): 673 - 679. [Abstract] [Full Text]
|
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