Primary coronary angioplasty versus intravenous streptokinase in acute myocardial infarction: differences in outcome during a mean follow-up of 18 months.
BACKGROUND
Intravenous streptokinase and primary coronary angioplasty are both considered to be effective treatment strategies for patients with acute myocardial infarction. Although primary coronary angioplasty is associated with a high patency rate and a well-preserved left ventricular function, it is not known whether it results in a more favorable clinical outcome in randomized comparisons.


METHODS
Clinical data were obtained after a mean follow-up of 18 months (range 6-36 months) after random allocation of 301 patients either to intravenous streptokinase (n = 149) or to primary angioplasty (n = 152). The primary endpoint includes death from cardiac causes and non-fatal reinfarction. The secondary endpoint is a weighted unsatisfactory outcome, one that includes death, stroke, heart failure, shock, ejection fraction lower than 30%, reinfarction, reocclusion and bleeding complications. The need for revascularization procedures was recorded.


RESULTS
The relative risk of death from cardiac causes and non-fatal reinfarction in the streptokinase group was 6.1 (95% confidence interval 2.9-12.7) compared with the angioplasty group. There was a lower weighted unsatisfactory outcome score of 0.13 +/- 0.29 in patients randomly assigned to angioplasty compared with 0.34 +/- 0.33 in patients randomly assigned to streptokinase (P < 0.001). Coronary angioplasty or coronary artery bypass grafting, or both, were performed more often in the streptokinase group, with a relative risk of 2.1 compared with patients randomly assigned to angioplasty (95% confidence interval 1.5-3.2).


CONCLUSIONS
Clinical outcome in patients with acute myocardial infarction after a mean follow-up of 18 months was more favorable in patients randomly assigned to primary angioplasty compared with those receiving intravenous streptokinase.
Zijlstra
F
F
Department of Cardiology, Hospital de Weezenlanden, Zwolle, The Netherlands.
de Boer
M J
MJ
Ottervanger
J P
JP
Liem
A L
AL
Hoorntje
J C
JC
Suryapranata
H
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use*; D015996:Survival Rate; D015912:Thrombolytic Therapy
D013300:Streptokinase