[Anisoylated plasminogen streptokinase complex during the acute phase of myocardial infarction. Results of a multicenter double-blind study versus heparin].
Two hundred and thirty-one patients admitted to hospital within 5 hours of the onset of symptoms of a primary myocardial infarction were randomised into 2 groups: one received thrombolytic therapy [anisoylated plasminogen streptokinase activator complex (APSAC): 30 IU in 5 minutes] and the other was given conventional heparin therapy (5,000 IU). Heparin was given to both groups 4 hours later (500 IU/kg/day); the APSAC (N = 119) was identical with respect to age, location of infarct, Killip classification, delay before randomisation (188 +/- 62 minutes). Coronary angiography and ventriculography were performed after 3.4 +/- 1.2 days, and angioscintigraphy and myocardial scintigraphy after 19 +/- 2.5 days to determine the size of the infarct and the quality of left ventricular function. Coronary patency was much higher in the APSAC group (77%) than the heparin group (37%) (p less than 0.001). The angiographic ejection fraction was significantly greater in the thrombolytic group than in the heparin group (53 +/- 13% vs 47 +/- 12%, p less than 0.002), the difference being statistically significant in the anterior and inferior infarct subgroups. At the third week, the difference remained significant in the anterior infarct subgroup: a 31 per cent reduction in necrosed myocardial mass was observed in the APSAC group (33% in anterior infarcts: p less than 0.05 and 16% in inferior infarcts: NS). The limitation of infarct size explained the smaller reduction in left ventricular systolic function (r = 0.73; p less than 0.01). The hospital and one year mortality was comparable in the two groups which was not surprising given the small number of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Cassagnes
J
J
Service de cardiologie, CHRU, Clermont-Ferrand.
Bassand
J P
JP
Machecourt
J
J
Lusson
J R
JR
Anguenot
T
T
Borel
E
E
Vacher
D
D
Denis
B
B
Maurat
J P
JP
Jallut
H
H
D016255:Anistreplase; D017023:Coronary Angiography; D004311:Double-Blind Method; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010958:Plasminogen / Q000627:therapeutic use*; D011875:Radionuclide Angiography; D016032:Randomized Controlled Trials as Topic; D013300:Streptokinase / Q000627:therapeutic use*; D013318:Stroke Volume
D005343:Fibrinolytic Agents; D016255:Anistreplase; D010958:Plasminogen; D006493:Heparin; D013300:Streptokinase
Le complexe streptokinase plasminogène acylé à la phase aiguë de l'infarctus du myocarde. Résultats d'une étude multicentrique en double aveugle versus héparine.