Thrombolytic agents in acute myocardial infarction

Article Abstract:

During a heart attack or MI (myocardial infarction) part of the heart muscle dies because it is deprived of oxygen; this usually occurs because one of the coronary arteries is blocked by a blood clot or narrowed by placques caused by atherosclerosis. After a heart attack there is a danger of thrombosis (clot formation) within the heart which can result in stroke and other complications, including death. Although administration of thrombolytic therapy (clot-preventing drugs) soon after an acute myocardial infarction is routine and has been found to reduce mortality and preserve left ventricular function (the heart's main pumping chamber), the choice of the proper thrombolytic therapy remains unclear. The current medications being evaluated include streptokinase, urokinase, rt-PA, pro-urokinase, and anisoylated streptokinase plasminogen activator complex (APSAC). Large clinical trials of rt-PA have demonstrated a reduction in early mortality, and according to German research, APSAC is equally effective in this respect. APSAC, however, is not yet available in the U.S. where the choice of thrombolytic agents is usually between streptokinase or rt-PA. There appears to be little difference in left ventricular function associated with the use of either streptokinase or rt-PA. Debate is likely to continue over the choice of the most effective medication until large randomized clinical trials comparing thrombolytic agents are carried out.

Drug therapy, Tissue plasminogen activator, Fibrinolytic agents, Infarction, Thrombolytic drugs, editorial

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A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction

Article Abstract:

Immediate angioplasty may be more effective than treatment with thrombolytic therapy for patients who have suffered a heart attack. Thrombolytic therapy involves treatment with drugs to break up blood clots. Among 142 patients who suffered a heart attack, 70 underwent immediate angioplasty and 72 were treated with intravenous streptokinase. None of the patients who underwent angioplasty suffered another heart attack, compared with nine patients treated with streptokinase. Four patients who underwent angioplasty suffered unstable angina, or chest pain, compared with 14 patients treated with streptokinase. The artery involved in the heart attack was opened in 91% of the patients who underwent angioplasty, compared with 68% of the patients treated with streptokinase. Average stenosis, or narrowing, of the coronary artery was 36% among the patients who underwent angioplasty, compared with 76% among the patients treated with streptokinase.

Care and treatment, Angioplasty

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