[Usefulness of thrombolytic therapy with low doses of streptokinase in acute myocardial infarction].
BACKGROUND
The optimal dose of Streptokinase in the treatment of acute myocardial infarction is not well established. Apparently, the thrombolytic efficacy would not increase with doses over 750,000 units.


OBJECTIVE
To compare the effectiveness and safety of treatment with low doses of Streptokinase, ranging from 500,000 to 750,000 units, in patients with ST elevation acute myocardial infarction.


METHODS
From September 1993 to September 1998, the GEMI register of patients with acute myocardial infarction, was carried out in 37 hospitals, incorporating 4,938 patients. Of these, 1,631 patients received streptokinase. According to the administered dose of Streptokinase, patients were divided in two groups: 1,465 patients who received 1.5 millions U in 60 minutes (classical therapy group), and 166 patients with ischemic chest discomfort and either ST-segment elevation or left bundle-branch block on the electrocardiogram, who received 500,000 to 750,000 U streptokinase administered in no more than 30 minutes, with heparin, within 0 to 6 hours of symptom onset. Successful reperfusion, mortality, complications, and hospital outcome was evaluated in both groups.


RESULTS
The low dose group of patients had a better reperfusion criteria profile. No differences between groups were observed in patient evolution, mortality, maximum Killip classification, post myocardial infarction heart failure, ischemic complications, arrhythmias or mechanical complications.


CONCLUSIONS
These results suggest that streptokinase in low doses is at least as effective as classical therapy, in the treatment of ST elevation acute myocardial infarction.
Raffo
Carlos
C
Hospital Dr. Gustavo Fricke, Viña del Mar, Chile. docraffo@yahoo.com
Bartolucci
Jorge
J
Corbalán
Ramón
R
Aninat
Mauricio
M
Torres
Humberto
H
Prieto
Juan Carlos
JC
Lanas
Fernando
F
Chávez
Eduardo
E
Cumsille
Francisco
F
Nazzal
Carolina
C
D000368:Aged; D016009:Chi-Square Distribution; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D015425:Myocardial Reperfusion; D010147:Pain Measurement; D011446:Prospective Studies; D012307:Risk Factors; D013300:Streptokinase / Q000008:administration & dosage* / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D006493:Heparin; D003402:Creatine Kinase; D013300:Streptokinase