title: Myocardial salvage with streptokinase combined with nitroglycerine and verapamil in acute myocardial infarction.
abstract: We tested the hypothesis that preservation of left ventricular function results from treatment with intravenous streptokinase given in the first 2 hours from onset of acute transmural myocardial infarction together with nitroglycerine and verapamil. Thirty-three consecutive patients with onset of pain less than 2 hours prior to admission, received intravenous streptokinase 1.5 x 10(6) units with intravenous nitroglycerine and verapamil; 23 concurrently admitted "control" patients with pain onset 2-4 hours received intravenous nitroglycerine and verapamil only. Radionuclide ventriculographic assessment at 2 days revealed a significantly greater left ventricular ejection fraction in the streptokinase-treated patients (54.5 +/- 2.8 vs 46.1 +/- 2.9; P less than 0.05), which persisted at 28-35 days (50.1 +/- 2.3 vs 41.2 +/- 2.9; P less than 0.05). Streptokinase-treated patients had a significantly increased incidence of ischaemic events in the 35 days following infarction, but a lower incidence of death, congestive cardiac failure and non-fatal ventricular tachycardia than control group patients. Infarct-related artery patency assessed at 3-5 days was 94% in streptokinase-treated patients. We conclude that early presentation and treatment with intravenous streptokinase, nitroglycerine and verapamil is associated with a high incidence of successful thrombolysis and significant preservation of left ventricular function. Nitroglycerine and verapamil may augment the efficacy of streptokinase in this group of patients.
authors.affiliation: Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: K J
authors.initials: KJ
authors.lastname: Lee
authors.forename: J D
authors.initials: JD
authors.lastname: Horowitz
authors.forename: W J
authors.initials: WJ
authors.lastname: McKay
authors.forename: A J
authors.initials: AJ
authors.lastname: Goble
mesh_terms: D000208:Acute Disease; D004359:Drug Therapy, Combination; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D015425:Myocardial Reperfusion; D005996:Nitroglycerin / Q000627:therapeutic use*; D011877:Radionuclide Imaging; D013300:Streptokinase / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D014700:Verapamil / Q000627:therapeutic use*
chemical_list: D014700:Verapamil; D013300:Streptokinase; D005996:Nitroglycerin