Immediate coronary angioplasty versus intravenous streptokinase in acute myocardial infarction: left ventricular ejection fraction, hospital mortality and reinfarction

Department of Cardiology, Hospital de Weezenlanden, Zwolle, The Netherlands.

OBJECTIVES. The purpose of the present study was to compare intravenous streptokinase therapy with immediate coronary angioplasty without antecedent thrombolytic therapy with regard to left ventricular function and hospital mortality and reinfarction. BACKGROUND. Despite the widespread use of intravenous thrombolytic therapy and immediate percutaneous transluminal coronary angioplasty, these two strategies to treat patients with an acute myocardial infarction have only recently been compared in randomized trials. Coronary angioplasty has been shown to result in a higher patency rate of the infarct-related coronary artery, with a less severe residual stenotic lesion, compared with streptokinase therapy, but whether this more favorable coronary anatomy results in clinical benefit remains to be established. METHODS. We studied 301 patients with acute myocardial infarction randomly assigned to undergo immediate coronary angioplasty without antecedent thrombolytic therapy or to receive intravenous streptokinase therapy. Before discharge left ventricular ejection fraction was measured by radionuclide scanning. RESULTS. The in-hospital mortality rate in the streptokinase group was 7% (11 of 149 patients) compared with 2% (3 of 152 patients) in the angioplasty group (p = 0.024). In the streptokinase group recurrent myocardial infarction occurred in 15 patients (10%) versus in 2 (1%) in the angioplasty group (p < 0.001). Either death or nonfatal reinfarction occurred in 23 patients (15%) in the streptokinase group and in 5 patients (3%) in the angioplasty group (p = 0.001). Left ventricular ejection fraction was 44 +/- 11% (mean +/- SD) in the streptokinase group versus 50 +/- 11% in the angioplasty group (p < 0.001). CONCLUSIONS. These findings indicate that immediate coronary angioplasty without antecedent thrombolytic therapy results in better left ventricular function and lower risk of death and recurrent myocardial infarction than treatment with intravenous streptokinase.

This article has been cited by other articles:

				M. G. Lindholm, S. Boesgaard, J. J. Thune, H. Kelbaek, H. R. Andersen, L. Kober, and DANAMI-2 investigators Percutaneous coronary intervention for acute MI does not prevent in-hospital development of cardiogenic shock compared to fibrinolysis Eur J Heart Fail, July 1, 2008; 10(7): 668 - 674. [Abstract] [Full Text] [PDF]

				C. Asseburg, Y. Bravo Vergel, S. Palmer, E. Fenwick, M. de Belder, K. R Abrams, and M. Sculpher Assessing the effectiveness of primary angioplasty compared with thrombolysis and its relationship to time delay: a Bayesian evidence synthesis Heart, October 1, 2007; 93(10): 1244 - 1250. [Abstract] [Full Text] [PDF]

				J. R Timmer, J. P. Ottervanger, K. Thomas, J. C.A Hoorntje, M.-J. de Boer, H. Suryapranata, F. Zijlstra, and on behalf of the Zwolle myocardial infarction stud Long-term, cause-specific mortality after myocardial infarction in diabetes Eur. Heart J., June 1, 2004; 25(11): 926 - 931. [Abstract] [Full Text] [PDF]

				S Constantinides, T S N Lo, M Been, and M F Shiu Early experience with a helical coronary thrombectomy device in patients with acute coronary thrombosis. Heart, May 1, 2002; 87(5): 455 - 460. [Abstract] [Full Text] [PDF]

				G. Kabakci, O. Onalan, M. Kemal Batur, A. Yildirir, R. Cagrikul, T. Acil, L. Tokgozoglu, A. Oto, F. Ozmen, and S. Kes What is the Optimal Evaluation Time of the QT Dispersion After Acute Myocardial Infarction for the Risk Stratification? Angiology, July 1, 2001; 52(7): 463 - 468. [Abstract] [PDF]

				D. A. Taira, T. B. Seto, K. K. L. Ho, H. M. Krumholz, D. E. Cutlip, R. Berezin, R. E. Kuntz, and D. J. Cohen Impact of Smoking on Health-Related Quality of Life After Percutaneous Coronary Revascularization Circulation, September 19, 2000; 102(12): 1369 - 1374. [Abstract] [Full Text] [PDF]

				P. B. Berger, S. G. Ellis, D. R. Holmes Jr, C. B. Granger, D. A. Criger, A. Betriu, E. J. Topol, and R. M. Califf Relationship Between Delay in Performing Direct Coronary Angioplasty and Early Clinical Outcome in Patients With Acute Myocardial Infarction : Results From the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) Trial Circulation, July 6, 1999; 100(1): 14 - 20. [Abstract] [Full Text] [PDF]

				C. M. Gibson Primary Angioplasty Compared with Thrombolysis: New Issues in the Era of Glycoprotein IIb/IIIa Inhibition and Intracoronary Stenting Ann Intern Med, May 18, 1999; 130(10): 841 - 847. [Abstract] [Full Text] [PDF]

				E. Garcia, J. Elizaga, N. Perez-Castellano, J. A. Serrano, J. Soriano, M. Abeytua, J. Botas, R. Rubio, E. Lopez de Sa, J. L. Lopez-Sendon, et al. Primary angioplasty versus systemic thrombolysis in anterior myocardial infarction J. Am. Coll. Cardiol., March 1, 1999; 33(3): 605 - 611. [Abstract] [Full Text] [PDF]

				S. J. Brener, L. A. Barr, J. E. B. Burchenal, S. Katz, B. S. George, A. A. Jones, E. D. Cohen, P. C. Gainey, H. J. White, H. B. Cheek, et al. Randomized, Placebo-Controlled Trial of Platelet Glycoprotein IIb/IIIa Blockade With Primary Angioplasty for Acute Myocardial Infarction Circulation, August 25, 1998; 98(8): 734 - 741. [Abstract] [Full Text] [PDF]

				J. W. Kennedy Optimal Management of Acute Myocardial Infarction Requires Early and Complete Reperfusion Circulation, April 1, 1995; 91(7): 1905 - 1907. [Full Text]

				F. Leya, J. Fareed, and J. Walenga Acute Myocardial Infarction: Diagnosis and Management Clinical and Applied Thrombosis/Hemostasis, March 1, 1995; 1(2): 160 - 165. [Abstract] [PDF]

				J McMurray and A Rankin Recent Advances: Cardiology - I: Treatment of myocardial infarction, unstable angina, and angina pectoris BMJ, November 19, 1994; 309(6965): 1343 - 1350. [Full Text]

				ANGIOPLASTY VS. THROMBOLYSIS FOR ACUTE MI Journal Watch (General), April 22, 1994; 1994(422): 4 - 4. [Full Text]