RESUMO
To evaluate the benefits of intravenous streptokinase (SQIV) in acute myocardial infarction (AMI), we joined a group of ten Mexican university hospitals, that were coordinated by the National Institute of Cardiology of Mexico. We included patients less than 70 years of age admitted to the hospital with less than 6 hours from the onset of chest pain during their first myocardial infarction. All patients had ST segment elevation of 1.5 mm or more, and none had contraindication for SQIV. They received 1.5 millions of SQIV in one hour. Reperfusion criteria included absence of pain, ST segment reduction and a rapid rise and fall of enzyme levels. Angiographic criterion for reperfusion was the permeability of the affected coronary vessel. Of 66 patients studied, 57 (86%) had clinical reperfusion; of the 24 available angiographic studies, 92% demonstrated reperfusion. Eight (12%) of the patients had minor complications and 7 (10%) had serious complications. There were 0 deaths. We concluded that SQIV is a useful therapeutic procedure, easy to perform in general hospitals.
Assuntos
Infarto do Miocárdio/tratamento farmacológico , Reperfusão Miocárdica , Estreptoquinase/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Estreptoquinase/administração & dosagemRESUMO
Para evaluar la importancia del tiempo de inicio de la terapia fibrinolítica con estreptoquinasa por vía intravenosa (EQIV) en la reperfusión coronaria, se estudiaron 34 pacientes consecutivos, con menos de 6 horas de iniciada la sintomatología del episodio de infarto agudo del miocardio y a quienes se les administró 1.5 de estreptoquinasa en 1 hora. En todos se realizó coronariografía en las primeras 72 horas. Se correlacionó el tiempo de inicio de la EQIV con los hallazgos coronariográficos. Los pacientes se dividieron en 3 grupos. El grupo I, de 0 de 2 horas con 12 pacientes; el grupo II, de 2 a 4 horas con 13 pacientes y el grupo III, de 4 a 6 horas con pacientes. Se observó reperfusión angiográfica en 24 pacientes (70.2%), p < 0.05. En el grupo I se obtuvo recanalización en 10 (83.3%). En el grupo II, 9 (69%) y el grupo III, 5 (55.5%), con significación estadística solo en el grupo I (p < 0.05). En este estudio también se demuestra la utilidad de los criterios enzimáticos y electrocardiográficos para precidir si ocurre reperfusión. No hubo mortalidad relacionada con el procedimiento. Se concluye que se obtiene un porcentaje de reperfusion mayor, cuanto mas precoz es el inicio de la terapia fibrinolítica
Assuntos
Humanos , Infarto do Miocárdio/tratamento farmacológico , Estreptoquinase/administração & dosagem , Angiocardiografia , Infusões IntravenosasRESUMO
To evaluate the importance of early initiation of fibrinolytic therapy with intravenous streptokinase (IVSK), we studied 34 consecutive patients, within less than six hours of the onset of acute myocardial infarction, who were treated with 1.5 million units of intravenous streptokinase. All the patients had coronary angiograms in the first seventy two hours. We correlated the angiograms with the time of onset of the IVSK. The patients were divided into 3 groups: Group num. 1: From zero to two hours (twelve patients); Group num. 2: From two to four hours (13 patients); and Group num. 3: From four to six hours (nine patients). We had angiographic reperfusion in twenty-four patients (70.2%) P less than 0.05. We observed reopening in the patients of group num. 1 (83.3%); in group 2, nine patients (69%) and in group num. 3, five patients, (55.5%), with statistical significance only in group num. 1 (p less than 0.05). We also demonstrated the utility of the electrocardiographic and enzymatic criteria to predict reperfusion. No mortality was related to the procedure. We concluded that a higher percentage of reperfusion is obtained the sooner intravenous streptokinase therapy is initiated.