Circulation, Vol 77, 345-352, Copyright © 1988 by American Heart Association
JW Kennedy, GV Martin, KB Davis, C Maynard, M Stadius, FH Sheehan and JL Ritchie
Three hundred sixty-eight patients were randomly assigned to receive
intravenous streptokinase (IVSK) (n = 191) or standard therapy (n = 177) to
determine the efficacy of IVSK in the treatment of acute myocardial
infarction. The mean time to treatment was 3.5 hr. At 14 days there were 12
deaths in the treatment group (6.3%) and 17 deaths in the control group
(9.6%) (p = .23). Early mortality was related to infarct location. Fourteen
day mortality for anterior infarctions was 10.4% for treatment with IVSK
and 22.4% for control patients (p = .06) and was similar for IVSK-treated
patients with inferior infarctions, 4.0% vs 1.8% (p = .32). For those
randomized under 3 hr, 14 day mortality tends to be lower in treated
patients, 5.2% vs 11.5% (p = .11). There was significant improvement in
long-term survival for patients with anterior infarction; 2 year survival
was 81% for IVSK- treated patients and 65% for control patients (p = .05).
There was no improvement in survival for patients with inferior myocardial
infarction (p = .27). We conclude that patients with anterior myocardial
infarction have improved survival when treated within the first 6 hr of
symptoms. Patients with inferior infarction do not appear to have improved
survival with thrombolytic therapy. Some of this improvement in survival in
patients with anterior infarction may be due to a higher frequency of
revascularization procedures in the treatment group.
ARTICLES
The Western Washington Intravenous Streptokinase in Acute Myocardial Infarction Randomized Trial [published erratum appears in Circulation 1988 May;77(5):1037]
Department of Medicine, University of Washington, Seattle 98195.
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