Acute myocardial infarction treated with intravenous streptokinase: 6-year follow-up

Abstract Our objective was to investigate variables which, although occurring during the acute period, could influence the medium (1st year) and long-term (6th year) survival of infarcted patients. Of a total of 332 patients treated consecutively and prospectively according to the same protocol which included intravenous streptokinase, 305 survived the hospital phase and represent the study population. Mean patient age was 55.6 ± 10 years and mean follow-up time was 3.33 years, with 1008.59 patient-years. The clinical course of the group was analyzed according to the following variables: left ventricle ejection fraction, hypotension per/peri streptokinase infusion, CK-MB peak, previous myocardial infarction, number of obstructed coronaries, reinfarction, sex, ‘definitive' treatment, residual obstruction, age, pain/streptokinase infusion interval, patency of the ‘culprit' coronary and infarct location. Overall, patients survival was 93.8 ± 1.4% during the 1st year and 83.7 ± 2.6% at the 6th. The following groups showed significantly different (log-rank) survivals: (a) 1st year: 94.6% for absence and 82.6% for presence of reinfarction ( P = 0.0451); 97.9% for inferior and 91.4% for anterior infarct location ( P = 0.044); 96.4% for ejection fraction > 50% and 90.6% for ejection fraction ≤ 50% ( P = 0.0187); 96.5% for angioplasty/surgery and 90.1% for clinical treatment ( P = 0.0028); 95.5% for absence and 80.6% for presence of previous infarct ( P = 0.0001). (b) 6th year: 88.3% for ejection fraction > 50% and 73.9% for ejection fraction ≤ 50% ( P = 0.028); 87.4% for ≤ 65 and 66.4% for > 65 years ( P = 0.0114); 89.6% for aggressive and 76.8% for conservative treatment ( P = 0.013); 86.6% for absence and 60.7% for presence of previous infarct ( P = 0.0009).