Why the study?
Does the choice of intravenous thrombolytic agent (SK, tPA, or APSAC) affect mortality, safety, and cost-effectiveness in patients with acute myocardial infarction?
Does the choice of intravenous thrombolytic agent (SK, tPA, or APSAC) affect mortality, safety, and cost-effectiveness in patients with acute myocardial infarction?
Streptokinase is a more cost-effective thrombolytic agent for acute myocardial infarction compared to tPA or APSAC, with no significant difference in mortality reduction.
The properties and physiological effects of three currently FDA-approved thrombolytic agents, streptokinase (SK), tissue plasminogen activator (tPA), and anisoylated plasminogen activator complex (APSAC) are reviewed. All thrombolytic agents have been shown to reduce mortality postmyocardial infarction (MI). Comparative trials have failed to demonstrate a difference between the effects of tPA, SK, and APSAC on mortality. In addition, no consistent difference between the three agents on ejection fraction (EF) has been found despite a superior reperfusion rate with tPA at 90 min. Furthermore, reinfarction and interventional procedure rates were significantly higher after thrombolytic treatment, and the incidence of total strokes was higher with tPA than SK in some comparative studies. Based on analysis of the published megatrials, SK is a more cost-effective thrombolytic agent for patients with acute MI than tPA or APSAC.
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Shammas et al. (1993) studied this question.
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