title: Reperfusion in acute myocardial infarction. A multicentre randomised trial of early intracoronary streptokinase and intravenous anisoylated plasminogen streptokinase activator complex in the United States.
abstract: To compare the reperfusion potential of anisoylated plasminogen streptokinase activator complex (APSAC), administered intravenously, and intracoronary streptokinase (the accepted standard for comparison in the United States), a randomised multicentre reperfusion trial was undertaken in the United States. A preliminary evaluation of results was made, based on the first 93 patients. Patients with acute myocardial infarction were studied angiographically, and those with coronary occlusion grade 0 or 1 were randomised and treated within 6 hours from symptom onset (mean 3 hours 25 minutes) with intracoronary streptokinase (20,000U bolus, then 2000 U/minute), or APSAC (30U over 2 to 4 minutes). Reperfusion was defined by a blinded reader as grade 2 or 3 flow after 90 minutes. Entry characteristics of patients in the 2 groups were comparable. Reperfusion rates were similar [19/39 (49%) of evaluable streptokinase patients and 19/43 (44%) of APSAC patients] and were dependent on the initial occlusion grade [38% of patients with grade 0 (streptokinase = 10/27, APSAC = 13/34), but 71% of patients with grade 1 (9/12, 6/9, respectively); p less than 0.02]. Grade 1 occlusion was present in 30% of patients treated within 4 hours, versus 16% treated at over 4 hours (p = 0.3). APSAC as a 2 to 4 minute infusion was well tolerated, and the change in mean blood pressure was minor (-6 mm Hg). Thus, APSAC and streptokinase provide similar reperfusion results, but APSAC is easier to administer, and shows excellent haemodynamic tolerance.
authors.affiliation: LDS Hospital, University of Utah Medical School, Salt Lake City.
authors.forename: J L
authors.initials: JL
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D016255:Anistreplase; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010958:Plasminogen / Q000009:adverse effects / Q000627:therapeutic use*; D011897:Random Allocation; D013300:Streptokinase / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D016255:Anistreplase; D010958:Plasminogen; D013300:Streptokinase