Effects of intracoronary streptokinase and intracoronary nitroglycerin infusion on coronary angiographic patterns and mortality in patients with acute myocardial infarction

Journal Article · Wed Dec 05 23:00:00 EST 1984 · N.Engl. J. Med.; (United States)

DOI:https://doi.org/10.1056/NEJM198412063112301· OSTI ID:5808639

Rentrop, K P; Feit, F; Blanke, H; Stecy, P; Schneider, R; Rey, M; Horowitz, S; Goldman, M; Karsch, K; Meilman, H

Patients with a clinical diagnosis of acute myocardial infarction were randomly assigned to one of four treatment groups: intracoronary streptokinase, intracoronary nitroglycerin, intracoronary streptokinase and intracoronary nitroglycerin, or conventional therapy without initial angiography. Of 124 patients 122 sustained acute myocardial infarction. Initial angiography revealed total occlusion of the coronary artery responsible for infarction in 67 percent (61 of 91). Acute recanalization occurred in 74 percent (32 of 43) of patients receiving streptokinase but in only 6 percent (1 of 18) of patients treated with nitroglycerin alone. At angiography of all four groups on Day 10 to 14 the vessel responsible for acute myocardial infarction was patent in 77 percent (71 of 92) of patients; there was no difference among groups, indicating gradual, endogenous thrombolysis in patients not treated with streptokinase. Patients with subtotal obstruction initially had significant improvement in left ventricular function, significantly lower peak creatine kinase levels, and a trend toward lower mortality than patients with total occlusion initially. Mortality at six months in patients receiving streptokinase (21 percent, 13 of 62) did not differ significantly from that in patients not treated with streptokinase (10 percent, 6 of 61). Additional studies will be necessary to assess treatment effects in the angiographic subsets identified by this trial.

• Research Organization: Mount Sinai School of Medicine, New York, NY
• OSTI ID: 5808639
• Journal Information: N.Engl. J. Med.; (United States), Journal Name: N.Engl. J. Med.; (United States) Vol. 311:23; ISSN NEJMA
• Country of Publication: United States
• Language: English

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550602* -- Medicine-- External Radiation in Diagnostics-- (1980-)
62 RADIOLOGY AND NUCLEAR MEDICINE
BIOMEDICAL RADIOGRAPHY
BLOOD VESSELS
BODY
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
CHEMICAL EXPLOSIVES
DIAGNOSIS
DIAGNOSTIC TECHNIQUES
DISEASES
ENZYMES
ESTERS
EXPLOSIVES
HYDROLASES
MEDICINE
MORTALITY
MYOCARDIAL INFARCTION
NITRIC ACID ESTERS
NITROGLYCERIN
NUCLEAR MEDICINE
ORGANIC COMPOUNDS
ORGANS
PATIENTS
PEPTIDE HYDROLASES
RADIOLOGY
SH-PROTEINASES
STREPTOCOCCAL PROTEINASE
THERAPY