NEW YORK (Reuters Health) – Intracoronary streptokinase (ICSK) given immediately after percutaneous coronary intervention (PCI) reduces long-term myocardial infarction size and improves left ventricular volumes and function, Turkish researchers report.

In their randomized study, total myocardium involvement at 6 months after ST-segment elevation acute myocardial infarction averaged 22.7% in patients treated with ICSK and 32.9% in the control group (p = 0.003).

Dr. Murat Sezer, from Istanbul University, Capa-Istanbul and colleagues had previously shown that treatment with ICSK after PCI could improve myocardial perfusion. The earlier cohort, however, was too small to assess long-term outcomes, such as infarct size and ventricular function.

The new study, reported in the Journal of the American College of Cardiology for September 15, featured 51 patients randomized to receive ICSK 250 kU immediately after PCI, and 44 who received no additional therapy.

Angiography, echocardiography, and SPECT were performed at 6 months to assess infarct size and left ventricular volumes and function. In addition to the reduction in infarct size, ICSK therapy was associated with lower left ventricular end-systolic volume (41.1 vs 60.9 mL, p = 0.009) and end-diastolic volume (95.5 vs 118.3 mL, p = 0.006) and higher ejection fraction (57.2% vs 51.8%, p = 0.018).

No significant differences in adverse events were noted between the groups during follow-up.

“Because the relation between infarct size and mortality is well known,” the 31% relative reduction in infarct size and the 10% absolute difference promise “a substantial prognostic benefit,” the researchers conclude.

Reference:
J Am Coll Cardiol 2009;54:1065-1071.