Intravenous versus intracoronary streptokinase for acute transmural myocardial infarction

Blunda, Michael; Meister, Steven G.; Shechter, Jay A.; Pickering, Nancy J.; Wolf, Nelson M.

doi:10.1002/ccd.1810100403

Cited by 14 publications

(5 citation statements)

References 24 publications

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“…Major bleeding complications appear to be similar in trials of IVSK versus ICSK [118,119,121,127,129,130]. Minor femoral hematomas occurred in 9% of NSK patients versus 1.6% of ICSK patients in the study by Taylor and co-workers [ 118].…”

Section: Complications Of Ivskmentioning

confidence: 86%

“…Data suggests that the risk of hypotension is related to the extent of damage to the myocardium, and that reductions in blood pressure may be avoided by limiting the rate of infusion of NSK [128]. z IVSK Versus ICSK Nine studies dealt specifically with the comparison of IVSK and ICSK in the treatment of AMI [117][118][119]121,127,[129][130][131][132][133]. Five of these studies were prospective randomized trials [117,119,121,130,131].…”

Section: Complications Of Ivskmentioning

confidence: 99%

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Analytic Review: Thrombolytic Therapy in Acute Myocardial Infarction

Zwerner

Gore

1986

J Intensive Care Med

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The salvage of myocardium in the setting of acute myocardial infarction has long been a goal of physicians involved in the care of patients with coronary artery disease. Understanding the role of thrombosis in the pathogenesis of acute myocardial infarction has led the way to an entirely new approach to the treatment of this entity. Thrombolytic therapy has now become a widely used form of treatment with encouraging results. Both intravenous and intracoronary administration of thrombolytic agents have been shown to promote recanalization of acutely occluded coronary arteries. Results of studies using the clot-specific agent, tissue plasminogen activator, intravenously have been most encouraging; successful reperfusion has been obtained in approximately 70% of patients treated. In addition, a recent large-scale trial has shown a reduction in morbidity and mortality with the early use of thrombolytic agents.Ongoing trials should help delineate the precise role and timing of these agents as the initial form of therapy for acute myocardial infarction. Other issues that remain unresolved are the frequency of restenosis and the role of percutaneous transluminal coronary angioplasty in addition to thrombolytic therapy in the treatment of acute myocardial infarction.Coronary heart disease is the leading cause of death in the United States; over one-half million individuals die from it each year. Between 5 and 6 million Americans have chronic, symptomatic coronary artery disease. In 1983, over 680,000 individuals were hospitalized with myocardial infarction [1]. J.The medical management of myocardial infarction has evolved gradually over the past 30 years, from a strategy of permitting the heart to heal by putting the patient and the heart to rest to increasingly more active monitoring in coronary care units with aggressive treatment of identified abnormalities. It is uncommon for a patient with myocardial infarction to die of a primary rhythm disturbance in the acute phases of infarction [2]. Today, extensive myocardial injury is the most common cause of death and morbidity among patients hospitalized with acute myocardial infarction (AMI) [1]. Massive myocardial ischemia produces pump failure and serious ventricular arrhythmias [3]. Thus, shortterm survival is intimately related to the size of myocardial infarction; loss of more than 40% of the left ventricular (LV) myocardium almost always results in death. The risk of death appears to decrease with decreasing infarct size.Methods to reduce the extent and severity of myocardial damage have therefore been sought. Myocardial damage results from the disparity between oxygen demand and delivery in ischemic tissue. To limit infarct size, one can attempt to reduce myocardial oxygen demands or improve myocardial oxygen supply. Attempts to limit infarct size and improve early survival in AMI by pharmacologically decreasing myocardial oxygen demands have been disappointing [4][5][6]. Beta blockers have been shown to improve long-term survival when used prophylactically [7,8], a...

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Section: Complications Of Ivskmentioning

confidence: 86%

Section: Complications Of Ivskmentioning

confidence: 99%

Analytic Review: Thrombolytic Therapy in Acute Myocardial Infarction

Zwerner

Gore

1986

J Intensive Care Med

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“…The following are compared between ICSK and IVSK groups: (1) Duration from onset of symptoms to the initiation of treatment. three were prospective but nonrandom (Blunda et al, 1984;Taylor et al, 1984;Valentine et al, 1985), and one compared IVSK patients with previously treated ICSK patients (Geft et al, 1983). The sample size in the IVSK groups ranged from 12 to 12 1 ; the corresponding numbers for the ICSK groups were 13 to 85.…”

Section: Methodsmentioning

confidence: 99%

“…Only in four studies was angiography performed prior to and during treatment with IVSK (Alderman et al, 1984;Blunda et al, 1984;Rogers et al, 1983;Saltups et al, 1984). The rest of the trials did not document the infarct-related vessel prior to the initiation of IVSK therapy.…”

Section: Methodsmentioning

confidence: 99%

Intravenous versus intracoronary streptokinase in acute myocardial infarction

1985

Clinical Cardiology

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Summary: Nine studies specifically dealing with the comparison of intravenous streptokinase (IVSK) and intracoronary streptokinase (ICSK) in the treatment of acute myocardial infarction (MI) were analyzed to determine if IVSK is as efficacious as ICSK in achieving thrombolysis. Pooled data from the studies yielded success rates of 73% for IVSK and 72% for ICSK. Considering that the studies which did not perform preintervention angiogram may have overestimated the thrombolytic success rate in IVSK patients, there is a possibility that ICSK may be slightly more effective in achieving acute reperfusion. Bleeding complications were similar, and a systemic lytic state was observed in both treatment groups. No definitive conclusions can be drawn regarding the differences between groups in improvements of left ventricular function and mortality rates. ICSK has the advantage of direct documentation of reperfusion and spares the patient the risk of anticoagulation should the attempt fail. On the other hand, IVSK is cheaper, easier to administer, and can logistically be given earlier (even in the emergency room or ambulance) than ICSK; it is therefore more widely available, and may be the preferred mode of treatment in community hospitals where cardiac catheterization facilities are not readily available, if streptokinase is to be given at all.

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“…These benefits largely outweigh the somewhat lower reperfusion rates observed with the intravenous formulation (Alderman et al 1984;Anderson et al 1984;Blunda et al 1984;Natarajan et al 1988;Rogers et al 1983;Woollard et al 1984). As delay in the commencement of thrombolytic therapy reduces the benefit to the patient, attention has focused on intravenous rather than intracoronary administration of streptokinase which confers the advantages of speed of administration and availability outside of specialised coronary catheterisation facilities.…”

Section: Therapeutic Efficacy In Acute Myocardial Infarction In the Ementioning

confidence: 99%

Streptokinase

Battershill¹,

Benfield²,

Goa³

1994

Drugs & Aging

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Streptokinase has been administered to many thousands of elderly patients with acute myocardial infarction. Results of large, randomised trials provide convincing evidence that intravenous streptokinase confers a distinct survival benefit in this population subgroup following myocardial infarction. The placebo-controlled ISIS-2 study demonstrated a 5-week absolute mortality reduction of 38 per 1000 patients aged 60 to 69 years administered streptokinase, compared with only 16 per 1000 for patients aged less than 60 years. Combining streptokinase with aspirin further reduces mortality, as shown by a 5-week absolute mortality reduction of 70 per 1000 patients aged 60 to 69 years administered this regimen in the ISIS-2 trial. While ideally patients should receive streptokinase as soon as possible after symptom onset, late benefit has been observed in patients presenting up to 12 hours after pain onset, as is often the case with the elderly. Indeed, in patients treated > 6 hours after infarct in the GUSTO trial, streptokinase produced lower mortality results than accelerated recombinant tissue plasminogen activator (rt-PA). However, in contrast to the similar effects of streptokinase and conventionally administered rt-PA on overall survival demonstrated in previous large trials, the GUSTO study showed a lower mortality rate for accelerated rt-PA than for streptokinase in the elderly and in the total patient population. The most frequent adverse effects associated with streptokinase therapy are haemorrhagic complications, with an incidence of 0.4% for major bleeding (requiring transfusion) and 3.6% for minor bleeding among the total population in the GISSI-1 and ISIS-2 trials. An excess of stroke, particularly haemorrhagic stroke, occurring with rt-PA in GUSTO and other major mortality trials affirms the use of streptokinase as a suitable option in the elderly who are at increased risk of this complication. Significantly reduced values of end-systolic volume and regional wall motion index have been observed in elderly patients following streptokinase therapy. Overall, streptokinase and rt-PA seem to cause similar improvements in left ventricular function in this age group. Patency of occluded coronary arteries appears to be achieved in a high percentage of elderly patients following streptokinase therapy, based on a small sample. Thus, in view of the extensive clinical experience that now exists, intravenous streptokinase represents an appropriate alternative in elderly patients with acute myocardial infarction, and may be considered a first-line therapy in selected individuals, such as those with multiple risk factors for stroke or who present later than 6 hours after infarct.(ABSTRACT TRUNCATED AT 400 WORDS)

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Intravenous versus intracoronary streptokinase for acute transmural myocardial infarction

Cited by 14 publications

References 24 publications

Analytic Review: Thrombolytic Therapy in Acute Myocardial Infarction

Analytic Review: Thrombolytic Therapy in Acute Myocardial Infarction

Intravenous versus intracoronary streptokinase in acute myocardial infarction

Streptokinase

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