Subject(s)
Heart Injuries/etiology , Thoracic Injuries/complications , Wounds, Nonpenetrating/complications , Accidents, Traffic , Coronary Angiography , Echocardiography , Electrocardiography , Follow-Up Studies , Heart Injuries/diagnosis , Heart Injuries/physiopathology , Humans , Male , Middle AgedABSTRACT
Forty-five consecutive patients with transmural anterior acute myocardial infarction were prospectively studied to determine the effect of intravenous streptokinase on the incidence of left ventricular thrombi. Three patients died. The remaining patients were divided into 2 groups. Group 1 patients (n = 22) received 750,000 units of intravenous streptokinase within 6 hours of onset of symptoms. Neither thrombolytic therapy or anticoagulants were administered to 18 patients in group 2. Cross-sectional echocardiography was performed 8 to 10 days following acute myocardial infarction to detect left ventricular thrombus. Technically satisfactory echocardiography was not possible in 2 patients. Apical akinesia or dyskinesia was observed in all patients. No patient in the treated group developed left ventricular thrombus compared with 8 of 18 (44.4%) in group 2 (P less than 0.05). One patient in the control group sustained an embolic cerebrovascular accident. Thus intravenous streptokinase significantly reduces the incidence of left ventricular thrombus formation in patients of transmural anterior acute myocardial infarction.
Subject(s)
Heart Ventricles , Myocardial Infarction/drug therapy , Streptokinase/administration & dosage , Thrombosis/drug therapy , Aged , Echocardiography , Heart Ventricles/drug effects , Humans , Infusions, IntravenousABSTRACT
To assess the relative efficacy of coronary thrombolysis using intracoronary versus intravenous streptokinase, 32 patients with acute myocardial infarction were randomly assigned to receive intracoronary (n = 17) and intravenous streptokinase (n = 15). All patients underwent selective coronary arteriography before and after administration of streptokinase by either route within 4 hours of the onset of symptoms. Intravenous streptokinase was given as 750,000 units over 30 minutes, while a mean dose of 180,000 units was required for thrombolysis in the group having intracoronary delivery. Recanalization occurred in 71.4% (10 of 14) of patients receiving streptokinase, by the intracoronary group in contrast to only 25% of patients (3 of 12) who received the drug intravenously (P less than 0.05). Spontaneous thrombolysis was seen in 17.6% and 20% of the patients in the groups having intracoronary and intravenous delivery, respectively. Bleeding complications were few in both groups. Thus, when baseline coronary arteriography is performed, recanalization with intracoronary streptokinase is more effective in the treatment of acute myocardial infarction than intravenous streptokinase.
