title: Streptokinase versus alteplase: comparison of echocardiographic parameters and post-coronarography treatment--our experience.
abstract: BACKGROUND
  Usage of fibrinolytic therapy leads to reperfusion of the occluded coronary arteries, rescue of ventricle myocardium and successful recovery of patient.
  
  
  OBJECTIVE
  The objective of this study was to compare the reperfusion effect of streptokinase and alteplase in acute myocardial infarction (AMI) by analyzing echocardiographic parameters and post-coronarography treatment.
  
  
  METHODS
  We observed 53 patients in AMI and divided them depending on applied therapy in streptokinase and alteplase group. Both groups were further divided into three subgroups depending on the time passed from chest pain occurrence to admission at Clinic. Observed echocardiographic parameters were: mitral regurgitation, left ventricular systolic and diastolic function and signs of ischemic cardiomyopathy. On coronary angiogram we analyzed severity of coronary artery disease as well as recommended treatment thereafter.
  
  
  RESULTS
  There were no significant difference in post-coronarography treatment, incidence and severity of mitral regurgitation and ischemic cardiomyopathy in alteplase vs streptokinase group- only significantly less diastolic dysfunction was noted in alteplase group (p=0.037). We noticed only significant difference when we took into consideration time from chest pain to admission at clinic. In alteplase first subgroup were more patients treated only with medications (without need for revascularization) vs streptokinase first subgroup (62,5% vs 28.6%, p=0.047). In alteplase first subgroup was lower incidence of mitral regurgitation (p =0.045), developed cardiomyopathy (p =0.009) and more preserved left ventricular diastolic function (p =0.008) compared to first streptokinase subgroup.
  
  
  CONCLUSIONS
  In our study we have found a significant difference between streptokinase and alteplase in echocardiographic parameters and post-coronarography treatment when we took into consideration time from occurrence of chest pain to admission at Clinic. The best outcomes had patients who were treated with alteplase within 1.5 hour from occurrence of chest pain.
authors.affiliation: Clinic for Heart disease and rheumatism, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina. resicnerma@yahoo.com
authors.forename: Nerma
authors.initials: N
authors.lastname: Resic
authors.affiliation: Clinic for Heart disease and rheumatism, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Azra
authors.initials: A
authors.lastname: Durak-Nalbantic
authors.affiliation: Clinic for Heart disease and rheumatism, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Alen
authors.initials: A
authors.lastname: Dzubur
authors.affiliation: Clinic for Heart disease and rheumatism, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Enisa
authors.initials: E
authors.lastname: Hodzic
authors.affiliation: Center for the Heart, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Mehmed
authors.initials: M
authors.lastname: Kulic
authors.affiliation: Clinic for Heart disease and rheumatism, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Nirvana
authors.initials: N
authors.lastname: Sabanovic-Bajramovic
authors.affiliation: Clinic for Heart disease and rheumatism, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Elmedina
authors.initials: E
authors.lastname: Jahic
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003971:Diastole; D004452:Echocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013300:Streptokinase / Q000627:therapeutic use*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator