ACYL PLASMINOGEN STREPTOKINASE VERSUS HEPARIN IN RECENT ACUTE MYOCARDIAL INFARCTION. PRELIMINARY REPORT OF A FRENCH INTERUNIVERSITY TRIAL

One hundred and twenty seven patients (pts) suffering from a first acute myocardial infarction (AMI) were included in a multicenter trial involving three University Hospitals and 22 community Hospitals without catheterization facilities. Patientswere randomly allocated within 5 hours following the onset of symptoms either to acyl plasminogen streptokinase (APSAC) 30 IU within 5 min followed 4 hours later by heparin at a dose of 500 IU/kg/day or to conventional Heparin (H) therapy 500 IU/kg/day. 63 pts received APSAC and 64 received H. Both APSAC and H groups were similar in age, location of AMI, Killip class and time of randomization. After initial therapy Pts were referred to the University Hospitals and submitted between Day 1 and Day 7 to a selective coronary angiography and immediate percutaneous transluminal angioplasty (PTCA) of the infarct-related artery if suitable for the procedure.4 APSAC pts and 2 H pts died during the hospital course (NS).The arterial patency rate determined on average 3.4 ± 1.2 days after the onset of symptoms was 88% in APSAC and 42% in H (P<.001). 15 APSAC pts and7 H pts were submitted to PTC A with one failure in each group. LVEF and akinetic score (AK) were determined from left ventricular angioeraDhy :On Day 14, pts were submitted to Ti 201 scan and to radionuclide angiography (RNA). Results are not yet available.Our results showed that early infusion of APSAC in AMI produced a high short term patency-rate of the IRA with a tendancy toward improvement of the left ventricular systolic function which failed to reach statistical significance because of the relatively small size of the cohort.