Accelerated streptokinase in ST-elevation myocardial infarction--a Romanian (ASK-ROMANIA) multicenter registry.
BACKGROUND
The classical streptokinase regimen (1.5 M.U. over 60 min) may be too slow in patients with ST-elevation myocardial infarction (STEMI).


OBJECTIVE
To compare the efficacy and safety of four streptokinase regimens in STEMI patients.


METHODS
1880 consecutive patients admitted within 6 h of STEMI onset were allocated one of the following four streptokinase regimens: 1.5 M.U. over 60 min (n=517); 1.5 M.U./30 min (n=355); 1.5 M.U./20 min (n=507); 0.75 M.U./10 min, repeated or not after 50 min if no electrocardiographic criteria of reperfusion (n=501).


RESULTS
Rates of coronary reperfusion (non-invasively detected) for SK1.5/30 (72.39%), SK1.5/20 (75.34%) and SK0.75/10 (72.85%) were similar and higher than for SK1.5/60 (64.03%, p=0.019, p<0.0001, and p=0.006, respectively). In-hospital mortality was significantly lower for SK1.5/20 (7.10%) and SK0.75/10 (7.38%) and at the limit of significance for SK1.5/30 (7.60%) compared with SK1.5/60 (11.60%, p<0.0001, 0.006, and 0.053, respectively). Intracerebral haemorrhage and other major bleeding had similar incidence in the four groups.


CONCLUSIONS
Compared to the classical 1.5 M.U. over 60 min streptokinase regimen, significantly higher rates of coronary reperfusion and lower in-hospital mortality can be obtained by infusing the same dose over only 20 min, or either one or two half doses over only 10 min, without risk increase.
Tatu-Chiţoiu
Gabriel
G
Spitalul Clinic de Urgenţă Floreasca, Clinica de Medicină Internă şi Cardiologie, Bucureşti, Romania. ro_stemi@yahoo.com
Dorobanţu
Maria
M
Teodorescu
Cristina
C
Craiu
Elvira
E
Vintilă
Marius
M
Minescu
Bogdan
B
Burghină
Daniel
D
Stamate
Sorin
S
Serban
Luminiţa
L
Protopopescu
Tudor
T
Dan
Monica
M
Căpraru
Petre
P
Guran
Manuela
M
Istrătescu
Oana
O
Vlădoianu
Mircea
M
Caea
Nicoleta
N
D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D015425:Myocardial Reperfusion / Q000379:methods; D012042:Registries; D012383:Romania; D013300:Streptokinase / Q000008:administration & dosage*; D013997:Time Factors
D013300:Streptokinase