Intracoronary Streptokinase in Acute Myocardial Infarction A review

The attempt to salvage myocardium threatened by ischemia during temporary or permanent occlusion of one or more of the nutrient arteries, is based on the observation that the major determinant of survival is the extent to which myocardium has been lost through infarction. Modern clinical cardiology has therefore looked at various approaches which might limit unnecessary loss of potentially viable myocardium. These are attempts to reduce the oxygen consumption through pharmacological means, attempts at restoring the blood supply and oxygen delivery at an early stage by manipulations on the coronary arteries and interventions aimed at "protecting" cardiac cells threatened by ischemia or reperfusion. Endpoints considered to be proof of improved left ventricular function will be wall motion and ejection fraction measurements as well as reduction in death rate and other serious cardiovascular complications. Although final proof from prospective randomized studies, one of which is carried out at this institution with intracoronary streptokinase in over 300 patients, will not be available at the time of this presentation, arguments will be provided which indicate that restoration of blood supply at an early stage, preferably supported by pharmacological therapy with beta-blockade and calcium antagonists, is to be preferred inasmuch as current data indicate improved function, and in certain subsets, improved life expectancy.