ABSTRACT
In a multicentre trial of streptokinase in acute myocardial infarction 302 patients received an intravenous infusion of 2 500 000 IU of streptokinase over 24 hours, while 293 patients served as controls. Neither group received anticoagulants unless indicated by thromboembolic complications. No significant difference in mortality was evident during inpatient treatment nor at six-week or six-month follow-up. The inpatient death rate was 12-6% in the streptokinase group and 13-7% among controls. There was no significant difference in the peak levels or pattern of enzyme increase. The incidence of cardiac failure and reinfarction was similar in the two groups, but major arrhythmias were less common in those on streptokinase (P less than 0-05). In the streptokinase group there were 36 minor and six more serious haemorrhagic complications. Gastrointestinal haemorrhage may have contributed to the death of one patient in each group. There were 18 thromboembolic complications in the streptokinase group and 38 among the controls. Pathological examination of the hearts of 25 patients who had taken streptokinase and 24 controls showed no striking differences between the groups, but haemorrhagic infarcts were found in three patients who had received streptokinase. An infusion of streptokinase within 24 hours of the onset of acute myocardial infarction does not significantly affect the mortality or course of the illness up to six months.
Subject(s)
Myocardial Infarction/drug therapy , Streptokinase/therapeutic use , Aged , Arrhythmias, Cardiac/complications , Aspartate Aminotransferases/blood , Clinical Trials as Topic , Female , Fibrin Fibrinogen Degradation Products/analysis , Heart Arrest/complications , Hemorrhage/complications , Humans , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Myocardial Infarction/mortality , Prognosis , Streptokinase/administration & dosage , Thromboembolism/complications , United KingdomABSTRACT
A total of 342 patients with acute myocardial infarction who were admitted to a coronary care unit are reviewed to assess the results of early mobilization and discharge. The mean duration of admission was 8.4 days and 89% of the survivors were discharged from hospital by the tenth day. The inpatient mortality was 15.5%. An additional 6.7% died during the six weeks' follow-up period, giving a total mortality of 22.2%. Altogether, 7.6% of patients were readmitted. Venous thromboembolic phenomena occurred in 3.5% during the inpatient period. Of patients who were eligible 62% were back at work five months after their myocardial infarction. We think the results justify a short hospital admission period for acute myocardial infarction.
