Accelerated Streptokinase versus Standard Dose Streptokinase in ST-Elevation Myocardial Infarction in Nakornping Hospital

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND Background: ST-segment elevation myocardial infarction (STEMI) patients who do not have primary percutaneous coronary intervention (PPCI) as an immediate option, should have fibrinolysis initiated expeditiously. A standard dose of streptokinase (SK) is 1.5 MU infusion at 30 to 60 minutes, as recommend by ESC and ACCF/AHA. An accelerated dose of SK is 0.75 MU over 10 minutes with a repeated dose at 50 minutes if there is an absence of electrocardiography reperfusion, It has been demonstrated that an accelerated dose of SK was associated with higher rates of coronary reperfusion than the standard dose of SK in patients with acute STEMI. Objective: The present study sought to compare the efficacy and safety between the standard dose SK and the accelerated SK regimens. Materials and Methods: The present research was a retrospective cohort study. The authors reviewed the medical record of patients admitted to the cardiac care unit in Nakornping Hospital due to acute STEMI between January 2017 and December 2018. The efficacy calculation was the coronary perfusion rate at 90 minutes after starting SK infusion. The safety calculation was the incidence of thrombolysis in myocardial infarction (TIMI) major bleeding and the in-hospital mortality. Results: There were 423 STEMI patients in CCU of Nakornping Hospital, 211 patients were treated with SK infusion, but 87 patients from the 211 patients were excluded due to missing data. Therefore, 124 patients were included in the present study. Baseline characteristics were comparable between the two groups. The rate of coronary reperfusion was numerically higher in the accelerated SK dose (60.2%) than in the standard dose (57.1%), but this difference did not reach statistical significance (p=0.81). No TIMI major bleeding occurred in both groups. There was no statistically significant difference in the hospital mortality rates (accelerated SK dose 3.9% versus standard dose 9.5%, p=0.27). Conclusion: The efficacy and safety of the accelerated SK dose was comparable with the standard dose SK in STEMI patients in Nakornping Hospital.