Importance of early initiation of intravenous streptokinase therapy for acute myocardial infarction

David G. Fine, Avraham Teddy Weiss, Dan Sapoznikov, Sima Welber, David Applebaum, Chaim Lotan, Yonathan Hasin, Yosef Ben-David, Gideon Koren, Mervyn S. Gotsman

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38 Scopus citations

Abstract

The importance of timing of intravenous streptokinase (SK) administration in patients with acute myocardial infarction (AMI) was evaluated. Intravenous SK, 750,000 U, was administered within 4 hours of the onset of ischemic chest pain to 72 consecutive patients having their first AMI. Six days later, cardiac catheterization was performed to calculate global ejection fraction (EF), and computer-derived infarct-related regional EF and dysfunction index were also determined; electrocardiograms were recorded, from which QRS scores could be calculated to estimate infarct size. Of 19 patients who had an anterior AMI, 12 (63%) who received intravenous SK within 2 hours after onset of pain sustained only minimal damage in terms of global EF, infarct-related EF, dysfunction index and QRS score. All 10 patients who received SK 2 to 4 hours after pain onset had large infarcts (p < 0.001). Of the former group, 11 of 12 patients (91%) whose pain was relieved within 1.5 hours of intravenous SK administration (presumably due to successful reperfusion) had a good outcome, whereas all 7 whose pain lasted longer did poorly (p < 0.001). Furthermore, among patients with anterior AMI, 11 of 14 (79%) whose pain was relieved within 3.5 hours of onset had small infarcts, compared with none of the 12 patients whose pain lasted longer (p < 0.0001). In inferior AMI, the critical time between onset of pain and initiation of intravenous SK was 1.5 hours (p < 0.05). The timing of initiation of thrombolytic therapy and the total pain duration are critical in determining outcome in AMI, and time intervals vary depending on infarct localization.

Original languageEnglish
Pages (from-to)411-417
Number of pages7
JournalAmerican Journal of Cardiology
Volume58
Issue number6
DOIs
StatePublished - 1 Sep 1986
Externally publishedYes

Bibliographical note

Funding Information:
From the Departments of Cardiology, Hadassah University Hospitals, Ein Karem, Mount Scopus and Magen David Adorn Emergency Service, Jerusalem, Israel. Dr. Fine is recipient of an Israel Ministry of Health Research Fellowship administered by the Fogarty International Center. This study represents partial fulfillment by S. Welber for the MSc degree at Hebrew University, Jerusalem, Israel. This study was supported in part by Ha-dassah Associates, Los Angeles, California. Manuscript received January 20, 1986; revised manuscript received April 18, 1986, accepted April Z&1986.

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