Accelerated Streptokinase Infusion Regimen Versus Standard Infusion Regimen in STEMI Patients. A Randomized Clinical Trial to Compare Clinical and Angiographic Outcomes

Coronary heart disease is the single largest cause of death in the developed countries. ST-segment elevation myocardial infarction (STEMI) can be treated by primary PCI, thrombolytics or pharmaco-invasive strategy. Streptokinase (SK) is the most widely used fibrinolytic agent in developing countries.SK in acute STEMI has a wide debate about the sufficient dose of infusion.

To improve the outcome of thrombolytic treatment in STEMI patients in terms of angiographic findings.

A randomized controlled double blinded trial was conducted on 120 adult patients presenting to Suez Canal university cardiac care unit with acute STEMI. Divided into two groups, group A n (60) that received SK in an accelerated infusion protocol over 30 minutes, and group B n (60) who received SK over 60 minutes. Clinical echocardiographic and angiographic outcomes were studied in both groups.

Echocardiographic parameters in the study group were significantly better. RWMA index was 1.56±0.11 in group B, compared to 1.38±0.08 in group A. Mean E/e’ in group A was 12.97±1.29 and 14.5±0.83 in group B . Myocardial blush grade, myocardial TIMI score and myocardial frame count were all statistically significant (p<0.001) favoring accelerated SK infusion protocol. The mean time for chest pain relief was 65 minutes in group A and 80 minutes in group B (p<0.001). Score of ST segment resolution in group A was 1.5±0.504 and 1±0.368 in the control group. With no evidence of clinically significant complications in the study group. Only one patient had intracranial hemorrhage and died.

This study deduced that accelerated protocol was a safe and effective method for administration of STK, there was no significant increase in major bleeding in the control group, and heart failure, arrhythmias and mechanical complications were clinically insignificant to raise any alarm against the use of the accelerated protocol.

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