To determine the efficacy of intravenous
streptokinase in acute
myocardial infarction, 52 patients were randomized to intravenous
streptokinase or control groups. Time from onset of
infarction to randomization was similar in the
streptokinase group and control group, 4.9 +/- 2.1 hours vs 5.4 +/- 2.4 hours, respectively. The 28
streptokinase patients received an
intravenous infusion of 700,000 units of
streptokinase followed by full-dose anticoagulation. The 24 control patients received
normal saline solution followed by full-dose anticoagulation. Of 28
streptokinase patients, 12 (43%) had noninvasive evidence of reperfusion by early peaking of serum
creatine kinase (peak
creatine kinase less than 16 hours after onset of
infarction) vs 3 of 24 control patients (13%), p less than 0.02. Two
streptokinase patients (7%) had reperfusion arrhythmias during
streptokinase infusion. One
streptokinase patient (4%) and two control patients (8%) died during hospitalization. At angiography (16 +/- 5 days after
infarction) 22 of 26
streptokinase patients (85%) had a patent
infarct-related coronary artery compared to 8 of 20 control patients (40%), p less than 0.01. Comparison of
radionuclide left ventricular ejection fraction assessed acutely (28 +/- 10 hours after
infarction) with left ventricular ejection fraction at hospital discharge (15 +/- 3 days after
infarction) showed no significant improvement in either the
streptokinase or control group, 0% and +1%, respectively. At follow-up 13 +/- 7 months after
infarction, total mortality rate was similar in the
streptokinase group and control group, 17.8% (5 of 28
streptokinase patients) and 20.8% (5 of 24 control patients), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)