Background. Acute myocardial infarction (AMI) is the leading cause of death in the world. Fibrinolytic therapy combined with aspirin and heparin significantly decreased mortality and reduced the infarction area resulting in larger increases in the preservation of myocardial contractility compared with previous conventional treatment.
Objective To study the efficacy and safety of accelerated streptokinase regimen in patients with ST segment elevation myocardial infarction(STEMI) compared to standard regimen.
Methods One hundred patients with STEMI were included in this prospective, controlled study. Patients were classified into two groups, group I included 50 patients who received accelerated streptokinase regimen (1.5 MU over 20 minutes) and group II included 50 patients who received standard streptokinase (1.5 MU over 60 minutes). Efficacy was evaluated none invasively using clinical (chest pain), electrocardiographic (ST segment resolution), and laboratory tests
(early peaking of cardiac markers). Safety was evaluated by assessment of the risk of bleeding. Results There was no significant difference between the study groups in age, sex, other risk factors of coronary artery disease (CAD), past history of CAD, previous coronary interventions, time interval between the onset of chest pain and the start of streptokinase and site of infarction as suggested by ECG. 37 patients (74%) had successful reperfusion in group I versus 24 patients
(48%) in group II, p= 0.01. There was significant difference between both groups regarding each of the parameters of reperfusion. No major bleeding was reported in both groups. The incidence of minor bleeding was higher in group I (20%) compared to group II (14%) but without a statistically significant difference, p= 0.1. There was a significantly higher incidence of streptokinase induced hypotension in group I, 30 patients (60%) compared to 12 patients (24%) in group II, p= 0.001.
Conclusions An accelerated regimen of streptokinase is significantly better than the conventional regimen in achieving higher coronary reperfusion in cases of acute STEMI. The accelerated streptokinase
regimen is well tolerated without increased risk of major bleeding.