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. 1983 Dec;10(4):387–395.

Streptokinase Thrombolysis in Acute Myocardial Infarction: A Turning Point

Paolo Angelini 1, Richard Leachman 1
PMCID: PMC344368  PMID: 15226973

Abstract

The initial anatomic findings of angiography during acute myocardial infarction, as well as the techniques used for selective coronary streptokinase infusion, are presented in this report.

Preliminary evaluation of streptokinase infusion studies seems to indicate that revascularization of coronary arteries occluded during myocardial infarction is quickly and easily achievable and could constitute the treatment of choice; however, critical questions still remain to be answered.

Recanalization rates vary from 75 to 90% in the different, usually small, series. The time of recanalization seems critical to the salvage of ventricular myocardium; e.g., recanalizations accomplished before a time lapse of 3 to 4 hours appear to limit infarct size, whereas, results appear doubtful after that time. The early mortality rate is similar to that of patients not treated with streptokinase, but the mortality at 1 month and 6 months is apparently in favor of the treated group.

While thrombolytic agents may not turn out to be the panacea that some researchers have expected, recent experience has greatly contributed to the understanding of the pathophysiology of myocardial infarction and the critical importance of the time factor in planning therapy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barlow G. H. Pharmacology of fibrinolytic agents. Prog Cardiovasc Dis. 1979 Mar-Apr;21(5):315–326. doi: 10.1016/0033-0620(79)90004-5. [DOI] [PubMed] [Google Scholar]
  2. Baroldi G., Falzi G., Mariani F. Sudden coronary death. A postmortem study in 208 selected cases compared to 97 "control" subjects. Am Heart J. 1979 Jul;98(1):20–31. doi: 10.1016/0002-8703(79)90316-8. [DOI] [PubMed] [Google Scholar]
  3. Bett J. H., Castaldi P. A., Hale G. S., Isbister J. P., McLean K. H., O'Sullivan E. F., Biggs J. C., Chesterman C. N., Hirsh J., McDonald I. G. Australian multicentre trial of streptokinase in acute myocardial infarction. Lancet. 1973 Jan 13;1(7794):57–60. doi: 10.1016/s0140-6736(73)90463-7. [DOI] [PubMed] [Google Scholar]
  4. Cowley M. J., Hastillo A., Vetrovec G. W., Fisher L. M., Garrett R., Hess M. L. Fibrinolytic effects of intracoronary streptokinase administration in patients with acute myocardial infarction and coronary insufficiency. Circulation. 1983 May;67(5):1031–1038. doi: 10.1161/01.cir.67.5.1031. [DOI] [PubMed] [Google Scholar]
  5. DeWood M. A., Spores J., Notske R., Mouser L. T., Burroughs R., Golden M. S., Lang H. T. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980 Oct 16;303(16):897–902. doi: 10.1056/NEJM198010163031601. [DOI] [PubMed] [Google Scholar]
  6. Ganz W., Buchbinder N., Marcus H., Mondkar A., Maddahi J., Charuzi Y., O'Connor L., Shell W., Fishbein M. C., Kass R. Intracoronary thrombolysis in evolving myocardial infarction. Am Heart J. 1981 Jan;101(1):4–13. doi: 10.1016/0002-8703(81)90376-8. [DOI] [PubMed] [Google Scholar]
  7. Genton E. Thrombolytic therapy of pulmonary thromboembolism. Prog Cardiovasc Dis. 1979 Mar-Apr;21(5):333–341. doi: 10.1016/0033-0620(79)90006-9. [DOI] [PubMed] [Google Scholar]
  8. Mathey D. G., Kuck K. H., Tilsner V., Krebber H. J., Bleifeld W. Non surgical coronary artery recanalization in acute transmural myocardial infarction. Circulation. 1981 Mar;63(3):489–497. doi: 10.1161/01.cir.63.3.489. [DOI] [PubMed] [Google Scholar]
  9. Merx W., Dörr R., Rentrop P., Blanke H., Karsch K. R., Mathey D. G., Kremer P., Rutsch W., Schmutzler H. Evaluation of the effectiveness of intracoronary streptokinase infusion in acute myocardial infarction: postprocedure management and hospital course in 204 patients. Am Heart J. 1981 Dec;102(6 Pt 2):1181–1187. doi: 10.1016/0002-8703(81)90650-5. [DOI] [PubMed] [Google Scholar]
  10. Messmer B. J., Merx W., Meyer J., Bardos P., Minale C., Effert S. New developments in medical-surgical treatment of acute myocardial infarction. Ann Thorac Surg. 1983 Jan;35(1):70–78. doi: 10.1016/s0003-4975(10)61433-6. [DOI] [PubMed] [Google Scholar]
  11. Meyer J., Merx W., Schmitz H., Erbel R., Kiesslich T., Dörr R., Lambertz H., Bethge C., Krebs W., Bardos P. Percutaneous transluminal coronary angioplasty immediately after intracoronary streptolysis of transmural myocardial infarction. Circulation. 1982 Nov;66(5):905–913. doi: 10.1161/01.cir.66.5.905. [DOI] [PubMed] [Google Scholar]
  12. Morris A. L., Nernberg V., Roos N. P., Henteleff P., Roos L., Jr Acute myocardial infarction: survey of urban and rural hospital mortality. Am Heart J. 1983 Jan;105(1):44–53. doi: 10.1016/0002-8703(83)90277-6. [DOI] [PubMed] [Google Scholar]
  13. Reduto L. A., Smalling R. W., Freund G. C., Gould K. L. Intracoronary infusion of streptokinase in patients with acute myocardial infarction: effects of reperfusion on left ventricular performance. Am J Cardiol. 1981 Sep;48(3):403–409. doi: 10.1016/0002-9149(81)90066-7. [DOI] [PubMed] [Google Scholar]
  14. Rentrop P., Blanke H., Karsch K. R., Kaiser H., Köstering H., Leitz K. Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation. 1981 Feb;63(2):307–317. doi: 10.1161/01.cir.63.2.307. [DOI] [PubMed] [Google Scholar]
  15. Rentrop P., De Vivie E. R., Karsch K. R., Kreuzer H. Acute coronary occlusion with impending infarction as an angiographic complication relieved by a guide-wire recanalization. Clin Cardiol. 1978 Aug;1(2):101–106. doi: 10.1002/clc.4960010209. [DOI] [PubMed] [Google Scholar]
  16. Richards D. A., Cody D. V., Denniss A. R., Russell P. A., Young A. A., Uther J. B. Ventricular electrical instability: a predictor of death after myocardial infarction. Am J Cardiol. 1983 Jan 1;51(1):75–80. doi: 10.1016/s0002-9149(83)80014-9. [DOI] [PubMed] [Google Scholar]
  17. Roberts W. C., Buja L. M. The frequency and significance of coronary arterial thrombi and other observations in fatal acute myocardial infarction: a study of 107 necropsy patients. Am J Med. 1972 Apr;52(4):425–443. doi: 10.1016/0002-9343(72)90033-2. [DOI] [PubMed] [Google Scholar]
  18. Rutsch W., Schartl M., Mathey D., Kuck K., Merx W., Dörr R., Rentrop P., Blanke H. Percutaneous transluminal coronary recanalization: procedure, results, and acute complications. Am Heart J. 1981 Dec;102(6 Pt 2):1178–1181. doi: 10.1016/0002-8703(81)90649-9. [DOI] [PubMed] [Google Scholar]
  19. Schelbert H. R., Henning H., Ashburn W. L., Verba J. W., Karliner J. S., O'Rourke R. A. Serial measurements of left ventricular ejection fraction by radionuclide angiography early and late after myocardial infarction. Am J Cardiol. 1976 Oct;38(4):407–415. doi: 10.1016/0002-9149(76)90455-0. [DOI] [PubMed] [Google Scholar]
  20. Schmutzler R., Heckner F., Körtge P., van de Loo J., Poliwoda H., Pezold F. A., Praetorius F., Zekorn D. Zur thrombolytischen Therapie des frischen Herzinfarktes. I. Einführung, Behandlungspläne, allgemeine klinische Ergebnisse. Dtsch Med Wochenschr. 1966 Apr 1;91(13):581–587. doi: 10.1055/s-0028-1110619. [DOI] [PubMed] [Google Scholar]
  21. Sherry S. Personal reflections on the development of thrombolytic therapy and its application to acute coronary thrombosis. Am Heart J. 1981 Dec;102(6 Pt 2):1134–1138. doi: 10.1016/0002-8703(81)90643-8. [DOI] [PubMed] [Google Scholar]
  22. Simon T. L., Ware J. H., Stengle J. M. Clinical trials of thrombolytic agents in myocardial infarction. Ann Intern Med. 1973 Nov;79(5):712–719. doi: 10.7326/0003-4819-79-5-712. [DOI] [PubMed] [Google Scholar]
  23. Smalling R. W., Fuentes F., Matthews M. W., Freund G. C., Hicks C. H., Reduto L. A., Walker W. E., Sterling R. P., Gould K. L. Sustained improvement in left ventricular function and mortality by intracoronary streptokinase administration during evolving myocardial infarction. Circulation. 1983 Jul;68(1):131–138. doi: 10.1161/01.cir.68.1.131. [DOI] [PubMed] [Google Scholar]

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