Effect of intravenous streptokinase on early mortality in patients with suspected acute myocardial infarction

Article Abstract:

A heart attack (myocardial infarction) may result from an occlusion of the arteries supplying blood to the heart (coronary arteries). Blood flow to the heart is reduced (myocardial ischemia) causing cardiac damage that can be life-threatening. Thrombolytic agents, such as streptokinase or tissue plasminogen activator, which dissolve the arterial occlusion thereby restoring blood flow are used to treat AMI. The effectiveness of thrombolytic therapy is well established in most cases; the benefit is less clear for patients with suspected acute inferior infarction. To further characterize the possible patient benefits of receiving thrombolytic therapy in cases of suspected acute anterior and inferior myocardial infarction, a review was performed of six selected articles in which a group of patients was given a particular dose range of intravenous streptokinase with or without other therapeutic agents. The results were compared with a similar group of patients who did not receive the streptokinase therapy. These six studies included 9,155 patients with suspected acute anterior myocardial infarction. Mortality was 17.4 percent for the control patients and 12.5 percent for the streptokinase-treated patients, demonstrating the recognized therapeutic effects of streptokinase administration. In the group with suspected acute inferior myocardial infarction (9,650 patients), the control group exhibited a mortality rate of 7.7 percent, while the rate for the streptokinase group was 6.6 percent. If these rates are applied to the population at large, 21 patients with suspected anterior myocardial infarction would need to be treated to save one life; and for the inferior myocardial infarction population, 125 additional patients would need to be treated to save one life. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality

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Coronary thrombolysis: streptokinase or recombinant tissue-type plasminogen activator?

Article Abstract:

The most common cause of acute myocardial infarction (heart attack) is the blockage of a coronary artery by a blood clot. If untreated, the blockage starves the heart muscle of oxygen and results in permanent damage, and perhaps death. The speedy opening of such a blockage is crucial to treatment, and clinicians now have a tool which can accomplish this task effectively. Thrombolysis, which is the use of enzymes to dissolve the clot, has been shown in numerous clinical studies to reestablish the circulation in many blocked arteries and to significantly reduce mortality due to acute myocardial infarction. Several enzymes are currently approved for use: recombinant tissue-type plasminogen activator (rtPA), which is manufactured by genetic engineering; streptokinase, a bacterial enzyme; urokinase, an enzyme obtained from urine; and acylated plasminogen streptokinase activator complex (APSAC). Different clinical studies have employed various designs, making comparison between studies difficult; relative reductions in mortality are also difficult to assess. However, careful comparison suggests that rtPA is more effective than streptokinase, producing both more rapid and more complete reperfusion of the heart. This improved effectiveness is more pronounced when treatment is begun rapidly after the infarction occurs. The side effects and potential complications, the most serious of which is hemorrhage, are comparable for the two enzymes. Small trials have suggested that this improvement in reperfusion translates into an improvement in mortality, but the confirmation of this awaits a larger controlled trial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Plasminogen activators

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Streptokinase and recombinant tissue plasminogen activator (rt-PA) are equally effective in treating acute myocardial infarction

Article Abstract:

A heart attack, or myocardial infarction, occurs when the blood supply to a portion of the heart muscle is suddenly cut off. This condition usually happens when a blood clot or fat deposits block one or more of the coronary arteries, which supply the heart. The treatment for myocardial infarction involves administering agents that dissolve blood clots and open the blocked arteries, restoring blood flow. Streptokinase and recombinant tissue plasminogen activator (rt-PA) are two agents that have been used to treat patients with myocardial infarction. Predictions were made that rt-PA would be twice as effective as streptokinase for the treatment of heart attack. However, these predictions were based on the results of studies using a test known as the 90-minute angiogram. This radiologic test measures the increase in blood flow to the heart muscle 90 minutes after a drug is given. The authors discuss the disadvantages of using this technique, and conclude that the 90-minute angiogram should not be used for comparing the effectiveness of streptokinase and rt-PA. A review of several recent studies, which included a total of 41,640 patients, indicated that rt-PA is not more effective than streptokinase in treating myocardial infarction, improving survival, or reducing the incidence of congestive heart failure and complications caused by hemorrhage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Tissue plasminogen activator

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