ECG and enzymatic indicators of therapeutic success after intravenous streptokinase for acute myocardial infarction--a pilot study.

The effect of intravenous streptokinase (SK) on time course of creatine kinase-MB (CK-MB) release and rapid reduction in ST-segment elevation as two non-invasive markers of reperfusion was prospectively studied in 83 patients with first anterior wall AMI (SK group, n = 61; control group, n = 22). CK-MB evidence of reperfusion in the SK group was significantly higher than that in the control group (80% versus 32%; P 0.0001). The rapid resolution of sum of ST segment elevations as an evidence of reperfusion was found in 82% patients in SK group versus 23% in the control group (P 0.0001). Both CK-MB and rapid resolution of ST segment elevations as evidences of reperfusion were found in 69% patients in SK and 14% in the control group (P 0.0001). The proportions of patients with non-invasive evidence of reperfusion with half-dose SK (750,000 units) regimen were comparable to that reported in the literature with full dose SK (1.5 million) regimen. Thus, serial CK-MB and ECG analysis in patients with AMI undergoing streptokinase therapy provides a non-invasive means for assessing therapeutic success. A dose of 750,000 units of SK was found clinically satisfactory using previously validated non-invasive markers of coronary reperfusion and produced results previously reported with 1.5 million units of SK.