High dose intravenous streptokinase in XXXX --short and long term prognosis.

@entity1 @entity1165 @entity548 @entity714 @entity908 @entity1188 @entity2224 @entity583 @entity943 @entity616
Streptokinase (1 million international units) was given intravenously over 30 or 60 minutes to 50 @entity1 four hours or less after the onset of @entity583 . All were aged less than or equal to 70 years and had 4 mm or greater ST segment elevation in anterior or inferior leads. Rapid (mean 95 min) ST segment resolution, which was taken to indicate reperfusion of the myocardium, occurred in 36 (72%) @entity1 . In these 36 the average time from onset of symptoms to peak @entity908 kinase, @entity908 kinase MB, and myoglobin was 9.45 hours, whereas it was 17 hours in the 14 @entity1 in whom indirect criteria did not indicate reperfusion. Reperfusion @entity943 were invariably present and @entity1165 developed in five @entity1 and @entity2224 in two. The @entity1188 related artery was seen to be open in 28 (70%) of the 40 @entity1 who had delayed coronary arteriography. The frequency of patency in the @entity1188 related artery was no different in @entity1 given streptokinase less than 2 hours or between 2-4 hours from onset of symptoms nor did it differ when streptokinase was infused over 30 or 60 minutes. Mean left ventricular ejection fraction was 57% in those with a @entity1 @entity1188 related artery and 48% in those with an occluded vessel. Eight @entity1 subsequently underwent elective percutaneous transluminal coronary angioplasty after successful thrombolysis and six had coronary artery bypass grafting. There were nine in-hospital reocclusions of the @entity1188 related coronary arteries. Two @entity548 episodes occurred; one required transfusion. Five of the 50 @entity1 died in hospital. All of them had had an anterior @entity583 ; four had @entity616 and one had @entity714 . During follow up, four @entity1 died, two suddenly and two from reinfarction. During follow up (mean 15 months) the frequency of reinfarction, dyspnoea, and angina was low and there was no difference in the proportions of @entity1 returning to work between those with an open @entity1188 related artery and those with a closed @entity1188 related artery. Intravenous administration of high dose streptokinase to selected @entity1 during the acute phase of @entity583 is a safe, effective, and practical method of thrombolysis. It must, however, be followed by coronary arteriography to select those @entity1 in whom percutaneous transluminal coronary angioplasty or coronary artery bypass grafting will be helpful.
