Thrombolytic therapy in acute myocardial infarction in Barbados: report of initial experience with intravenous streptokinase - abstract

ABSTRACT

It has been shown in the last decade, that intravenous throbolytic therapy is associated with a significant reduction in mortality, when given early in the course of an acute myocardial infarction (MI). Streptokinase, a bacterial-derived protein plasminogen activator, was approved for use at the Queen Elizabeth Hospital in June 1990 and thrombolytic therapy for acute MI commenced in October 1990. During the next 13 months, 129 patients were admitted to the Queen Elizabeth Hospital with the diagnosis of acute MI, and 35 of these (27 percent) received intravenous streptokinase. Nine other patients who received streptokinase were subsequently proven not to have infarcted. Forty-three per cent (43 percent) of the patients received thrombolytic therapy within six hours of the onset of symptoms, the ideal window period for treatment. Using non-invasive clinical criteria, reperfusion was suspected in 77 percent of patients. No major complications were seen. Three (3) patients had mild allergic reactions, and mild hypotension and bradycardia were seen in 19 patients. One patient who did not have an acute MI but an acute aortic dissection developed a hemiparesis which resolved within a week. There were 6 deaths recorded, all thought to be unrelated to streptokinase, but rather due to the extensive nature of the infarct. We have reported on a protocol-controlled series of patients given thrombolytic therapy for acute MI in Barbados, and have concluded that it can be given safely and effectively in carefully selected patients (AU)