Author + information
- Received August 11, 1987
- Revision received November 11, 1987
- Accepted November 18, 1987
- Published online April 1, 1988.
- James L Ritchie, MD, FACC∗,
- Manuel Cerqueira, MD,
- Charles Maynard, PhD,
- Kathryn Davis, PhD and
- J.Ward Kennedy, MD, FACC
- ↵∗Address for reprints: James L. Ritchic, MD, Division of Cardiology, Seattle VA Hospital, 1660 South Columbian Way, Seattle, Washington 98108.
The Western Washington Intravenous Streptokinase in Acute Myocardial Infarction Trial randomized 368 patients with symptoms and signs of acute myocardial infarction of < 6 h duration to either conventional care or 1.5 million units of intravenous streptokinase. The mean time to randomization was 209 min and 52% of patients were randomized within 3 h of symptom onset.
Quantitative, tomographic thallium-201 infarct size and radionuclide ejection fraction were measured at 8.2 ± 7.5 weeks in 207 survivors who lived within a 100 mile radius of a centralized laboratory. Overall, infarct size as a percent of the left ventricle was 19 ± 13% for control subjects and 15 ± 13% for treatment patients (p = 0.03). For anterior infarction in patients entered within 3 h of symptom onset, infarct size was 28 ± 13% in the control group versus 19 ± 15% for the treatment group (p = 0.09). Left ventricular ejection fraction was 47 ± 15% in the control versus 51 ± 15% in the treatment group (p = 0.08). For anterior infarction of <3 h duration, the ejection fraction was 38 ± 16% in the control versus 48 ± 20% in the treatment group (p = 0.13). By statistical analysis incorporating the nonsurvivors, p values for all of these variables were ≤0.08. There was no benefit for patients with inferior infarction or for anterior infarction of >3 h duration.
It is concluded that intravenous streptokinase, when given within 3 h of symptom onset to patients with anterior infarction, reduces infarct size and improves ventricular function.
☆ A list of Principal Investigators and iheir Associates in the Western Washington Intravenous Streptokinase Trial appears in the Appendix.
This work was supported by Grant HL 30300 from the National Heart, Lung, and Blood Institute. National Institutes of Health, Bethesda, Maryland, the W.M. Keck Foundation. Los Angeles, California, General Medical Research Service of the Veterans Administration, Washington, D.C. and the New England Nuclear Corp., North Billerica, Massachusetts.
- Received August 11, 1987.
- Revision received November 11, 1987.
- Accepted November 18, 1987.