| Popis: |
To compare the reperfusion potential of intravenous anisoy-lated plasminogen streptokinase activator complex (APSAC) a new thrombolytic, and standard therapy with intracoronary streptokinase in acute myocardial infarction (AMI), a randomized multicenter reperfusion trial was performed. Consenting patients with clinical signs of AMI and documented coronary occlusion (flow grade 0 or 1) were randomized to treatment within 6 hours of symptoms (mean, 3.4h) with intravenous APSAC (30 U in 2-4 min) or intracoronary streptokinase (bolus, then 2,000 U/min x 60 min). Reperfusion success was defined as grade 2 or 3 flow at 60 min for intracoronary and 90 min for intravenous therapy. A total of 189 patients (pt) were randomized and 179 pt were evaluable for efficacy. Reperfusion was similar for the two treatments: 52% (49/94) for APSAC and 61% (52/85) for streptokinase (p≤0.2). Success was dependent on initial occlusion grade (p≤0.001): 49% (65/133) for grade 0 (APSAC= 45%, streptokinase=54%), but 78% for grade 1 (APSAC=80%, strepto-kinase=77%). The success of intravenous (APSAC) therapy was also dependent on time to treatment: 59% for ≤4h, versus 36% after 4h (p |
