Streptokinase thrombolysis in acute myocardial infarction: a turning point.
The initial anatomic findings of angiography during acute myocardial infarction, as well as the techniques used for selective coronary streptokinase infusion, are presented in this report. Preliminary evaluation of streptokinase infusion studies seems to indicate that revascularization of coronary arteries occluded during myocardial infarction is quickly and easily achievable and could constitute the treatment of choice; however, critical questions still remain to be answered. Recanalization rates vary from 75 to 90% in the different, usually small, series. The time of recanalization seems critical to the salvage of ventricular myocardium; e.g., recanalizations accomplished before a time lapse of 3 to 4 hours appear to limit infarct size, whereas, results appear doubtful after that time. The early mortality rate is similar to that of patients not treated with streptokinase, but the mortality at 1 month and 6 months is apparently in favor of the treated group. While thrombolytic agents may not turn out to be the panacea that some researchers have expected, recent experience has greatly contributed to the understanding of the pathophysiology of myocardial infarction and the critical importance of the time factor in planning therapy.
Angelini
P
P
Cardiology Department, Texas Heart Institute of St. Luke's Episcopal and Texas Children's Hospitals, Houston, Texas, USA.
Leachman
R
R