Comparing effectiveness of tissue and plasma plasminogen activator thrombolysis in patients with various severity of acute myocardial infarction

Abstract

Aim. To compare alteplase (AL) and streptokinase (SK) effectiveness in patients with various severity of acute myocardial infarction (AMI). Material and methods. In retrospective analysis, 650 AMI patients were divided into three groups. Group I consisted of 183 subjects administered AL, Group II Р 232 individuals receiving SK, and Group III - 235 participants not administered any thrombolytic therapy (TLT). Each group was divided into three subgroups, according to Peel coronary prognostic index (CPI). Subgroup A included patients with Peel CPI of 1-8 points, Subgroup B Р 9-16 points, and subgroup C Р more than 16 points. Clinical outcomes of patients receiving AL, SK, or no TLT, were compared for all subgroups. Results. In Subgroup C, lethality in AL therapy (28.6%) was significantly lower than in SK therapy (50.0%) or no TLT (45.3%) (p<0.05). In subgroup B, lethality was lower for both AL and SK treatment (2.6% and 2.3%, respectively), comparing to no TLT (10.6%) (p<0.05). In this subgroup, both thrombolytic agents significantly decreased heart failure (HF) incidence. In subgroup A, AL more effectively than SK or no TLT reduced risk of HF, post-AMI angina, not affecting lethality or recurrent MI rates. Conclusion. AMI patients with low or high risk by Peel CPI should be administered AL. SK could be recommended for intermediate-risk AMI patients.

Keywords

• myocardial infarction
• thrombolytic therapy
• lethality
• heart failure
• recurrent myocardial infarction