Intravenous streptokinase did not significantly reduce 14-day mortality compared to standard therapy in acute myocardial infarction (6.3% vs 9.6%, p=0.23).
RCT (n=368)
Absolute Event Rate: 6.3% vs 9.6%
p-value: p=.23
Three hundred sixty-eight patients were randomly assigned to receive intravenous streptokinase (IVSK) (n = 191) or standard therapy (n = 177) to determine the efficacy of IVSK in the treatment of acute myocardial infarction. The mean time to treatment was 3.5 hr. At 14 days there were 12 deaths in the treatment group (6.3%) and 17 deaths in the control group (9.6%) (p = .23). Early mortality was related to infarct location. Fourteen day mortality for anterior infarctions was 10.4% for treatment with IVSK and 22.4% for control patients (p = .06) and was similar for IVSK-treated patients with inferior infarctions, 4.0% vs 1.8% (p = .32). For those randomized under 3 hr, 14 day mortality tends to be lower in treated patients, 5.2% vs 11.5% (p = .11). There was significant improvement in long-term survival for patients with anterior infarction; 2 year survival was 81% for IVSK-treated patients and 65% for control patients (p = .05). There was no improvement in survival for patients with inferior myocardial infarction (p = .27). We conclude that patients with anterior myocardial infarction have improved survival when treated within the first 6 hr of symptoms. Patients with inferior infarction do not appear to have improved survival with thrombolytic therapy. Some of this improvement in survival in patients with anterior infarction may be due to a higher frequency of revascularization procedures in the treatment group.
Kennedy et al. (Mon,) conducted a rct in acute myocardial infarction (n=368). intravenous streptokinase (IVSK) vs. standard therapy was evaluated on mortality at 14 days (p=.23). Intravenous streptokinase did not significantly reduce 14-day mortality compared to standard therapy in acute myocardial infarction (6.3% vs 9.6%, p=0.23).