doiSerbia

Comparative effect of streptokinase and alteplase on electrocardiogram and angiogram signs of myocardial reperfusion in ST segment elevation acute myocardial infarction

Tomašević Miloje (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Kostić Tomislav (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Apostolović Svetlana (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Perišić Zoran (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Đorđević-Radojković Danijela (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Koraćević Goran (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Šalinger-Martinović Sonja (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)

INTRODUCTION Modern pharmacological reperfusion in ST segment elevation acute myocardial infarction means the application of fibrin specific thrombolytics combined with modern antiplatelets therapy dual antiplateles therapy, acetylsalicylic acid and clopidogrel, and enoxaparin. The contribution of each agent has been widely examined in large clinical studies, but not sufficiently has been known about the effects of a combined approach, where the early angiography and percutaneous coronary intervention is added during hospitalization, if necessary. OBJECTIVE The aim of the paper is to compare the effects of streptokinase and alteplase, together with the standard modern adjuvant antiplatelets and anticoagulation therapy (aspirin, clopidogrel, enoxaparin) in patients with ST segment elevation acute myocardial infarction, on electrocardiographic and angiographic signs of the achieved myocardial reperfusion. METHOD The prospective study included 127 patients with the first ST segment elevation acute myocardial infarction who were treated with a fibrinolytic agent in the first 6 hours from the chest pain onset. The examined group included 40 patients on the alteplase reperfusion therapy, while the control 87 patients were on the streptokinase therapy. All the patients received the same adjuvant therapy and all were examined by coronary angiography on the 3rd to 10th day of hospitalization. Reperfusion effects were estimated on the basis of the following: ST segment resolution at 60, 90 and 120 minutes, the appearance of reperfusion arrhythmias at the electrocardiogram, percentage of residual stenosis at the 'culprit' artery, TIMI coronary flow at the 'culprit' artery and the appearance of new major adverse coronary events in the 6-month-follow-up period. RESULTS By analysing the resolution of the sum of ST segment elevation in infarction leading 60 minutes after the beginning of the medication application, we received a statistically significantly higher resolution of ST segment in the group of patients who received alteplase (p<0.05). 60 minutes after the application of thrombolytics, 64% of patients at streptokinase showed the absence of ST segment resolution (<30%), and 32% of patients at alteplase (p<0.0001). Reperfusion arrhythmias as the sign of successful myocardial reperfusion were present in 62.5% of patients at alteplase and in 57.4% of patients at streptokinase, but the difference is not statistically significant. There was no statistically significant difference in the degree of residual stenosis at the 'culprit' artery in the compared groups of patients. TIMI 3 flow was achieved in 75% of patients at alteplase and in 38% of patients at streptokinase (p<0.0001). There was no statistically significant difference in the frequency of major adverse coronary events in the 6-month-follow-up period after acute myocardial infarction. CONCLUSION Alteplase with modern adjuvant therapy of ST segment elevation acute myocardial infarction shows the earlier achievement of coronary perfusion as well as better coronary flow compared to streptokinase. There is no statistically significant difference in the frequency of reperfusion arrhythmias, degree of residual stenosis at the 'culprit' artery and the frequency of new coronary events in the 6-month-follow-up period after acute myocardial infarction.

Keywords: myocardial reperfusion, ST segment elevation acute myocardial infarction, fibrinolysis