Myocardial Reperfusion with Streptokinase in an Asian Population with Acute Myocardial Infarction: Analysis of 60-Minute ST Resolution

Aims: We sought to determine the efficacy of streptokinase in myocardial reperfusion in an Asian population with acute myocardial infarction by using 60-minute ST resolution and the predictors of complete ST resolution. Materials and Methods: We conducted a retrospective study on 96 consecutive Asian patients with acute myocardial infarction. All received streptokinase and had interpretable electrocardiograms (ECGs) before and 60 minutes after streptokinase initiation. ST resolution was categorised into three groups: complete (≥70%), partial (30% to < 70%) and no (0% to < 30%). Independent predictors of complete resolution were identified by multivariate analysis. The incidence of complete, partial, and no ST resolution was 24%, 27%, and 49% respectively. Independent predictors of complete ST resolution were inferior infarction (OR 7.82; CI 2.58-23.68; p=0.0003) and smoking history (OR 5.2; CI 1.42-19.07; p=0.0147). In a subgroup of patients (n=43) with interpretable ECGs at both 60 and 90 minutes, the incidence of complete, partial and no ST resolution changed from 12%, 23%, and 65% to 26%, 44%, and 30% respectively (p=0.01). Conclusion: Streptokinase restored myocardial perfusion in 24% of an Asian population 60 minutes after initiation. Independent predictors of myocardial reperfusion were inferior infarction and smoking history. The majority of patients without complete ST resolution at 60 minutes did not have successful myocardial reperfusion by 90 minutes without additional intervention.