Effects of streptokinase in patients presenting within 6 hours of prolonged chest pain with ST segment depression

BACKGROUND--The effects of streptokinase on the occurrence of a combined clinical outcome in patients presenting with recent chest pain and ST depression were investigated in view of the role of thrombus in the pathogenesis of acute ischaemic syndromes. METHODS--112 patients aged < or = 75 years...

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Published in:British Heart Journal 1995-06, Vol.73 (6), p.500-505
Main Authors: White, H. D., French, J. K., Norris, R. M., Williams, B. F., Hart, H. H., Cross, D. B.
Format: Article
Language:English
Subjects:
Aged
Angina, Unstable - drug therapy
Angina, Unstable - physiopathology
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Double-Blind Method
Electrocardiography
Female
Humans
Male
Medical sciences
Middle Aged
Myocardial Ischemia - physiopathology
Myocardial Ischemia - prevention & control
Pharmacology. Drug treatments
Streptokinase - therapeutic use
Thrombolytic Therapy
Time Factors
Treatment Outcome
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Summary:BACKGROUND--The effects of streptokinase on the occurrence of a combined clinical outcome in patients presenting with recent chest pain and ST depression were investigated in view of the role of thrombus in the pathogenesis of acute ischaemic syndromes. METHODS--112 patients aged < or = 75 years presenting within 6 h of the last episode of ischaemic chest pain of least 20 min duration with > or = 1 mm ST depression were randomised in a double blind manner to receive either streptokinase 1.5 million units over 30 min (n = 57) or placebo (n = 55). The primary end point was the combination of death, frequency of myocardial infarction (defined as peak creatine kinase > 600 U/ml), need for angiography because of uncontrollable ischaemia, and an exercise test within 35 days showing > or = 1 mm ST depression at < or = 6 min. The secondary end points were safety, frequency of chest pain, readmission with myocardial infarction or unstable angina, or need for revascularisation between 35 days and 1 year. The severity of ST depression on presentation was analysed with respect to clinical outcome. RESULTS--The frequency of the combined hierarchical end point of death, myocardial infarction, early angiography, and a positive exercise test was 82% (47 of 57 patients) with streptokinase and 75% (41 of 55 patients) with placebo. There were four deaths, two in each group. 27 patients (47%) receiving streptokinase and 22 (40%) receiving placebo developed myocardial infarction. 11 patients (eight streptokinase and three placebo) required coronary arteriography and subsequent revascularisation because of angina uncontrolled by medical treatment. 44 patients (22 in each group) had a positive exercise test. There were three further cardiac deaths (one streptokinase, two placebo), and three noncardiac deaths within 1 year. A conservative approach to intervention was adopted and over a period of 1 year 29 patients (26%) (13 streptokinase and 16 placebo) underwent revascularisation procedures. Three patients (two streptokinase and one placebo) required transfusion. ST depression > or = 3 mm had 90% specificity but only 60% positive predictive value for myocardial infarction at presentation (P = 0.008, stepwise logistic regression). ST depression > or = 2 mm was predictive of death, late development of myocardial infarction, or a need for angiography (P = 0.02). CONCLUSION--Patients presenting with ischaemic chest pain and ST depression frequently develop myocardial infarction. Sev
ISSN:0007-0769
1355-6037
1468-201X
2053-5864
DOI:10.1136/hrt.73.6.500