fibrinolytic therapy in patients with st-segment elevation myocardial infarction: accelerated versus standard streptokinase infusion regimen

Introduction: timely fibrinolysis for acute st-segment elevation myocardial infarction (stemi) reduces infarct size and hence preserves lv function and reduces mortality. optimal regimen of streptokinase (sk) infusion in such patients is a matter of interest. the current study aimed to compare efficacy and safety of accelerated sk infusion regimen in patients with stemi versus the standard one. methods: one hundred consecutive stemi patients were randomly allocated into one of 2 groups: group i (50 patients) who received accelerated sk regimen (1.5 million units over 30 minutes) and group ii (50 patients) received standard sk regimen (1.5 million units over 60 minutes). efficacy was evaluated non-invasively using clinical (chest pain), ecg (resolution of st segment) and laboratory tests (earlier and higher peaking of cardiac troponin i). safety was evaluated by assessment of multiple in-hospital adverse events.results: both groups were statistically matched in all baseline criteria. there was a significant difference between both groups regarding each parameter of successful reperfusion in favor of accelerated regimen. when all these parameters were combined, 31 patients (62%) had successful reperfusion in group i versus 19 patients (38%) in group ii (p = 0.016). we did not report any significant difference between both groups regarding in-hospital mortality, in-hospital heart failure, major bleeding, hypotension or allergic reaction to sk. mean pre-discharge ejection fraction was higher in group i than group ii (50.9 ± 6.6% versus 47.3 ± 4.6%, p = 0.002). conclusion: accelerated regimen of sk infusion is safe and effective method of reperfusion in patients with stemi.