title: Primary coronary angioplasty versus intravenous streptokinase in acute myocardial infarction: differences in outcome during a mean follow-up of 18 months.
abstract: 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.
authors.affiliation: Department of Cardiology, Hospital de Weezenlanden, Zwolle, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Zijlstra
authors.forename: M J
authors.initials: MJ
authors.lastname: de Boer
authors.forename: J P
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: A L
authors.initials: AL
authors.lastname: Liem
authors.forename: J C
authors.initials: JC
authors.lastname: Hoorntje
authors.forename: H
authors.initials: H
authors.lastname: Suryapranata
mesh_terms: 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
chemical_list: D013300:Streptokinase