Early clinical evaluation of the intravenous treatment of acute myocardial infarction with anisoylated plasminogen streptokinase activator complex.
50 consecutive patients with acute myocardial infarction and symptoms of less than 4 hours duration were treated with anisoylated plasminogen streptokinase activator complex (APSAC) 30U intravenously as a bolus injection over 5 minutes. An open infarct-related artery was found in 32 patients (64%) when the first coronary angiography was taken 66 +/- 21 minutes after APSAC. Complete reperfusion was subsequently seen in 10 of 18 patients with an occluded infarct-related artery 74 +/- 16 minutes after injection of APSAC. Thus, a patient infarct-related artery was seen in 42 patients (84%) within 68 +/- 20 minutes. A control coronary angiography was performed in 37 patients (74%) after 25 +/- 19 days. Reocclusion was found in 5 patients. The minimal cross-sectional area of the residual coronary stenosis increased from 1.3 +/- 0.9 mm2 to 1.8 +/- 1.9 mm2. Patients with residual thrombi after coronary thrombolysis (n = 13) demonstrated an increase of the minimal cross-sectional area of the residual stenosis from 1.2 +/- 0.8 to 2.6 +/- 2.3 mm2, whereas those without residual thrombi showed only minor changes of the minimal cross-sectional area (1.3 +/- 0.9 to 1.2 +/- 1.2 mm2). Thus, APSAC demonstrated a high patency rate and a low reocclusion rate after intravenous administration. The prolonged fibrinolytic activity of APSAC leads to a further regression of the residual coronary stenosis among patients with coronary thrombi after reperfusion.
Kasper
W
W
Klinikum der Albert-Ludwigs-Universität, Med. Universitäts Klinik, Abteilung Innere Medizin III, Kardiologie, Freiburg.
Meinertz
T
T
Wollschläger
H
H
Bonzel
T
T
Chen
C
C
Hofmann
T
T
Zeiher
A
A
Drexler
H
H
Just
H
H
D000328:Adult; D000368:Aged; D016255:Anistreplase; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010958:Plasminogen / Q000009:adverse effects / Q000627:therapeutic use*; D013300:Streptokinase / Q000009:adverse effects / Q000627:therapeutic use*; D014654:Vascular Patency / Q000187:drug effects
D005343:Fibrinolytic Agents; D016255:Anistreplase; D005340:Fibrinogen; D010958:Plasminogen; D013300:Streptokinase