A study of coronary artery patency in relation to the index event in patients with myocardial infarction thrombolysed with streptokinase.
BACKGROUND
Restoration of infarct vessel patency is the key treatment for acute ST-elevation myocardial infarction.


OBJECTIVE
The purpose of the study was to confirm the effectiveness of streptokinase (STK) for successful thrombolysis of the infarct-related artery (IRA) in patients with acute myocardial infarction (AMI), in relation to the time of the index event and age compared with newer thrombolytic agents, in a tertiary care centre.


METHODS
100 patients (77% male) thrombolysed with STK underwent coronary angiography within 48 h of presentation. Patency of the IRA was used to assess successful thrombolysis.


RESULTS
The mean pain-to-needle time was 3.24 h. 76 patients (76%) treated with thrombolysis had patent arteries with thrombolysis in myocardial infarction (TIMI) 2 or 3 flow. In subgroup analysis of time from the index event, patency rates were 83.3%, 77.5%, 68.7% and 40% in patients presenting within 0-2, 2-4, 4-6 and 6-12 h, respectively. In subgroup analysis, all patients less than 30 years of age had patent arteries with TIMI 2 or 3 flow. Coronary angiography showed the IRA was the left anterior descending artery (LAD) in 55%, the right coronary artery (RCA) in 33% and the left circumflex artery (LCX) in 12%. The patency rates of the LAD, RCA and LCX were 74.5%, 69.6% and 100%, respectively.


CONCLUSIONS
We found STK to be as effective as newer thrombolytic agents reported in other studies. In patients with AMI thrombolysed within 4 h, STK results in higher patency in young compared to older patients.
Department of Cardiology , Institute of Cardiology, JLN Medical College and Associated Group of Hospitals , Ajmer, Rajasthan , India.
R K
RK
Gokhroo
Department of Cardiology , Institute of Cardiology, JLN Medical College and Associated Group of Hospitals , Ajmer, Rajasthan , India.
Sajal
S
Gupta
Department of Cardiology , Institute of Cardiology, JLN Medical College and Associated Group of Hospitals , Ajmer, Rajasthan , India.
Devendra Singh
DS
Bisht
Department of Cardiology , Institute of Cardiology, JLN Medical College and Associated Group of Hospitals , Ajmer, Rajasthan , India.
Deepak
D
Padmanabhan