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.
This article has been cited by other articles:
 |
|
 |
|
  Part 8: Stabilization of the Patient With Acute Coronary Syndromes Circulation, December 13, 2005; 112(24_suppl): IV-89 - IV-110. [Full Text] [PDF]
|
|
|
|
 |
|
 H.-K. Yip, C.-J. Wu, M. Fu, K.-H. Yeh, T.-H. Yu, W.-C. Hung, and M.-C. Chen Clinical Features and Outcome of Patients With Direct Percutaneous Coronary Intervention for Acute Myocardial Infarction Resulting From Left Circumflex Artery Occlusion Chest, December 1, 2002; 122(6): 2068 - 2074. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Dixon, A. L. Bartorelli, P. A. Marcovitz, R. Spears, S. David, I. Grinberg, M. A. Qureshi, M. Pepi, D. Trabattoni, F. Fabbiocchi, et al. Initial experience with hyperoxemic reperfusion after primary angioplasty for acute myocardial infarction: Results of a pilot study utilizing intracoronary aqueous oxygen therapy J. Am. Coll. Cardiol., February 6, 2002; 39(3): 387 - 392. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Nicolau, C. V. Serrano Jr., S. A.C. Garzon, and J. A.F. Ramires Prognosis of acute myocardial infarction in the thrombolytic era: medical evaluation is still valuable Eur J Heart Fail, October 1, 2001; 3(5): 569 - 576. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Sechtem Imaging myocardial area at risk and final infarct size Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C36 - C46. [PDF]
|
|
|
|
|
|
E. M. Ohman, R. A. Harrington, C. P. Cannon, G. Agnelli, J. A. Cairns, and J.W. Kennedy Intravenous Thrombolysis in Acute Myocardial Infarction Chest, January 1, 2001; 119 (2009): 253S - 277S. [Full Text] [PDF]
|
|
|
|
 |
|
 P Chareonthaitawee, R J Gibbons, R S Roberts, T F Christian, and R Burns The impact of time to thrombolytic treatment on outcome in patients with acute myocardial infarction Heart, August 1, 2000; 84(2): 142 - 148. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, T. D. Miller, and T. F. Christian Infarct Size Measured by Single Photon Emission Computed Tomographic Imaging With 99mTc-Sestamibi : A Measure of the Efficacy of Therapy in Acute Myocardial Infarction Circulation, January 4, 2000; 101(1): 101 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. C. Chandra, R. C. Ziegelstein, W. J. Rogers, A. J. Tiefenbrunn, J. M. Gore, W. J. French, M. Rubison, and for the National Registry of Myocardial Infarction Observations of the Treatment of Women in the United States With Myocardial Infarction: A Report From the National Registry of Myocardial Infarction-I Arch Intern Med, May 11, 1998; 158(9): 981 - 988. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L White Thrombolytic Therapy in Acute Myocardial Infarction Part II: 1997 Update Asian Cardiovasc Thorac Ann, March 1, 1998; 6(1): 03 - 10. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Raitt, C. Maynard, G. S. Wagner, M. D. Cerqueira, R. H. Selvester, and W. D. Weaver Relation Between Symptom Duration Before Thrombolytic Therapy and Final Myocardial Infarct Size Circulation, January 1, 1996; 93(1): 48 - 53. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. Kellett and J. Clarke Comparison of "Accelerated" Tissue Plasminogen Activator with Streptokinase for Treatment of Suspected Myocardial Infarction Med Decis Making, October 1, 1995; 15(4): 297 - 310. [Abstract] [PDF]
|
|
|
|
|
|
K. L. Lee, L. H. Woodlief, E. J. Topol, W. D. Weaver, A. Betriu, J. Col, M. Simoons, P. Aylward, F. Van de Werf, and R. M. Califf Predictors of 30-Day Mortality in the Era of Reperfusion for Acute Myocardial Infarction : Results From an International Trial of 41 021 Patients Circulation, March 15, 1995; 91(6): 1659 - 1668. [Abstract] [Full Text]
|
|
|
|
|
|
C. Maynard, H. P. Selker, J. R. Beshansky, J. L. Griffith, C. H. Schmid, R. M. Califf, R. B. D'Agostino, M. M. Laks, K. L. Lee, G. S. Wagner, et al. The Exclusion of Women from Clinical Trials of Thrombolytic Therapy: Implications for Developing the Thrombolytic Predictive Instrument Database Med Decis Making, February 1, 1995; 15(1): 38 - 43. [Abstract] [PDF]
|
|
|
|
|
|
A. S. Midgette, J. B. Wong, J. R. Beshansky, A. Porath, C. Fleming, and S. G. Pauker Cost - Effectiueness of Streptokinase for Acute Myocardial Infarction: A Combined Meta-analysis and Decision Analysis of the Effects of Infarct Location and of Likelihood of Infarction Med Decis Making, April 1, 1994; 14(2): 108 - 117. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Zehender, W. Kasper, E. Kauder, M. Schonthaler, A. Geibel, M. Olschewski, and H. Just Right Ventricular Infarction as an Independent Predictor of Prognosis after Acute Inferior Myocardial Infarction N. Engl. J. Med., April 8, 1993; 328(14): 981 - 988. [Abstract] [Full Text]
|
|
|
|
 |
|
 M. H. Eckman, J. B. Wong, D. N. Salem, and S. G. Pauker Direct Angioplasty for Acute Myocardial Infarction: A Review of Outcomes in Clinical Subsets Ann Intern Med, October 15, 1992; 117(8): 667 - 676. [Abstract] [PDF]
|
|
|
|
 |
|
 S. B. Eysmann and P. S. Douglas Reperfusion and Revascularization Strategies for Coronary Artery Disease in Women JAMA, October 14, 1992; 268(14): 1903 - 1907. [Abstract] [PDF]
|
|
|
|
|
|
E. G. Bovill, M. L. Terrin, D. C. Stump, A. D. Berke, M. Frederick, D. Collen, F. Feit, J. M. Gore, L. D. Hillis, C. T. Lambrew, et al. Hemorrhagic Events during Therapy with Recombinant Tissue-Type Plasminogen Activator, Heparin, and Aspirin for Acute Myocardial Infarction: Results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial Ann Intern Med, August 15, 1991; 115(4): 256 - 265. [Abstract] [PDF]
|
|
|
|
|
|
T. F. Christian, I. P. Clements, T. Behrenbeck, K. C. Huber, J. H. Chesebro, B. J. Gersh, and R. J. Gibbons Limitations of the Electrocardiogram in Estimating Infarction Size after Acute Reperfusion Therapy for Myocardial Infarction Ann Intern Med, February 15, 1991; 114(4): 264 - 270. [Abstract] [PDF]
|
|
|
|
|
|
D. W. M. Muller and E. J. Topol Selection of Patients with Acute Myocardial Infarction for Thrombolytic Therapy Ann Intern Med, December 15, 1990; 113(12): 949 - 960. [Abstract] [PDF]
|
|
|
|
|
|
A. S. Midgette, G. T. O'Connor, J. A. Baron, and J. Bell Effect of Intravenous Streptokinase on Early Mortality in Patients with Suspected Acute Myocardial Infarction: A Meta-Analysis by Anatomic Location of Infarction Ann Intern Med, December 15, 1990; 113(12): 961 - 968. [Abstract] [PDF]
|
|
|
|
|
|
C. D. Naylor and S. B. Jaglal Impact of Intravenous Thrombolysis on Short-term Coronary Revascularization Rates: A Meta-analysis JAMA, August 8, 1990; 264(6): 697 - 702. [Abstract] [PDF]
|
|
|
|
|
|
D. Collen Coronary Thrombolysis: Streptokinase or Recombinant Tissue-Type Plasminogen Activator? Ann Intern Med, April 1, 1990; 112(7): 529 - 538. [Abstract] [PDF]
|
|
|
|
|
|
R. Peto, R. Collins, and P. Sleight Wider Inclusion Criteria Needed for Thrombolytic Therapy Ann Intern Med, September 15, 1989; 111(6): 540 - 540. [Abstract] [PDF]
|
|
|
|
|
|
T. H. Lee, M. C. Weisberg, D. A. Brand, G. W. Rouan, and L. Goldman Candidates for Thrombolysis among Emergency Room Patients with Acute Chest Pain: Potential True- and False-Positive Rates Ann Intern Med, June 15, 1989; 110(12): 957 - 962. [Abstract] [PDF]
|
|
|
|
 |
|
 E Haber, T Quertermous, G. Matsueda, and M. Runge Innovative approaches to plasminogen activator therapy Science, January 6, 1989; 243(4887): 51 - 56. [Abstract] [PDF]
|
|
|
|
 |
|
 THROMBOLYTIC THERAPY IMPROVES SURVIVAL AFTER ANTERIOR MI Journal Watch (General), February 26, 1988; 1988(226): 5 - 5. [Full Text]
|
|