A difference between front-loaded streptokinase and standard-dose recombinant tissue-type plasminogen activator in preserving left ventricular function after acute myocardial infarction (the Central Illinois Thrombolytic Therapy Study)

George J. Taylor, H. Weston Moses, Deborah Koester, Jerry A. Colliver, Richard E. Katholi, James T. Dove, Robert C. Woodruff, Frank L. Mikell, Lewis C. Becker, Florence H. Sheehan, W. T. Woods, David P. Hamm, Harry A. Wellons, Joel A. Schneider

Research output: Contribution to journalArticle

Abstract

A blinded, randomized trial compared the effects of front-loaded streptokinase with those of the conventional dose of intravenous recombinant tissue-type plasminogen activator (rt-PA) on left ventricular (LV) function after acute myocardial infarction (AMI). Thrombolytic therapy was administered in the emergency departments of 30 community hospitals in central Illinois, and subsequent studies were performed at 1 tertiary referral center. Patients aged {precedes above single-line equals sign}75 years with a first AMI who could be treated within 4 hours of the onset of chest pain were randomly assigned to receive either streptokinase (375,000 111 bolus, followed by 1,125,000 IU over 1 hour) or rt-PA (10 mg bolus, followed by 50 mg in the first hour, and 20 mg/hour for the next 2 hours). All patients were treated with aspirin (325 mg) and intravenous heparin. Patients were transferred for angiography within 24 hours. During the 30-month study, 253 patients were treated with intravenous thrombolytic therapy 2.4 ± 1.0 hour after the onset of AMI. In patients with anterior wall AMI (n = 90), global LV ejection fraction measured by angiography within 24 hours was 45 ± 12% with rt-PA, and 39 ± 13% with streptokinase (p < 0.03). Convalescent radionuclide angiography documented a persistent beneficial effect of rt-PA on LV regional wall contractility, but not global ejection fraction. There were no differences between rt-PA and streptokinase in preserving global or regional LV function in patients with inferior wall AMI.

Original languageEnglish (US)
Pages (from-to)1010-1014
Number of pages5
JournalThe American journal of cardiology
Volume72
Issue number14
DOIs
StatePublished - Nov 1 1993

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'A difference between front-loaded streptokinase and standard-dose recombinant tissue-type plasminogen activator in preserving left ventricular function after acute myocardial infarction (the Central Illinois Thrombolytic Therapy Study)'. Together they form a unique fingerprint.

  • Cite this

    Taylor, G. J., Moses, H. W., Koester, D., Colliver, J. A., Katholi, R. E., Dove, J. T., Woodruff, R. C., Mikell, F. L., Becker, L. C., Sheehan, F. H., Woods, W. T., Hamm, D. P., Wellons, H. A., & Schneider, J. A. (1993). A difference between front-loaded streptokinase and standard-dose recombinant tissue-type plasminogen activator in preserving left ventricular function after acute myocardial infarction (the Central Illinois Thrombolytic Therapy Study). The American journal of cardiology, 72(14), 1010-1014. https://doi.org/10.1016/0002-9149(93)90854-6