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June 5, 1986New England Journal of Medicine

A Prospective Trial of Intravenous Streptokinase in Acute Myocardial Infarction (I.S.A.M.)

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Why the study?

Does a one-hour intravenous infusion of streptokinase reduce mortality and infarct size in patients with acute myocardial infarction treated within six hours of symptom onset?

Population

1,741 patients up to 75 years of age presenting within six hours after the onset of symptoms of acute…

Comparison

Intravenous infusion of 1.5 million IU of… vs Placebo.

Design

RCT, Randomly assigned

Follow-up

21 days to 4 weeks

Discussion

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Overview

Early intravenous streptokinase in acute myocardial infarction limits infarct size and improves ejection fraction, though it showed only a non-significant trend toward reduced 21-day mortality.

Key Points

  • To determine whether early intravenous streptokinase infusion reduces mortality, limits infarct size, and preserves left ventricular function in acute myocardial infarction.
  • Randomized trial of 1,741 patients aged up to 75 years presenting within 6 hours of acute myocardial infarction symptom onset.
  • Patients received a 1-hour intravenous infusion of 1.5 million IU streptokinase or placebo.
  • Primary endpoints included 21-day mortality, enzymatic infarct size via serial CK-MB measurements, and 3-to-4-week angiographic ejection fraction (n = 848).
  • 21-day mortality was 6.3% in the streptokinase group versus 7.1% in the placebo group overall, and 5.2% (n = 477) versus 6.5% (n = 463) in patients treated within 3 hours (differences not statistically significant).
  • Time to peak serum CK-MB was significantly shorter (13.9 vs. 19.2 hours) and integrated CK-MB infarct size was significantly smaller in the streptokinase group (P < 0.02).
  • Angiography at 3–4 weeks demonstrated significantly higher global ejection fraction (56.8% vs. 53.9%, P < 0.005) and improved regional ejection fractions (P < 0.005) with streptokinase.

Structured PICO

Does a one-hour intravenous infusion of streptokinase reduce mortality and infarct size in patients with acute myocardial infarction treated within six hours of symptom onset?

P
Population
1,741 patients up to 75 years of age presenting within six hours after the onset of symptoms of acute myocardial infarction.
I
Intervention
Intravenous infusion of 1.5 million IU of streptokinase over one hour.
C
Comparator
Placebo.
O
Outcome
Mortality at 21 days.hard clinical

Early intravenous streptokinase in acute myocardial infarction limits infarct size and improves ejection fraction, though it showed only a non-significant trend toward reduced 21-day mortality.

Cite This Study

A 1986 study studied this question.

synapsesocial.com/papers/6a7ed1c9dd8171d0d19a1bf4https://doi.org/10.1056/nejm198606053142301
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