Summary of early clinical experience with anisoylated plasminogen streptokinase activator complex in the treatment of acute myocardial infarction.

Preliminary investigations using a single intracoronary dose of APSAC (up to 30U) revealed dissolution of intracoronary thrombi in 59 of 83 patients (71%) with acute myocardial infarction, as indicated by reperfusion of coronary arteries. Reocclusion of arteries occurred in 20.5% of patients. Based on these findings, a subsequent study was undertaken in 302 patients with evidence of recent acute myocardial infarction. Single intravenous bolus doses of APSAC (5 to 30U) produced reperfusion in 79% of patients, with reocclusion occurring in only 9% of patients receiving the higher doses. Adverse effects included an initial hypotension/bradycardia reaction, a later syndrome featuring pyrexia, nausea and vomiting, and bleeding complications, including 4 patients with cerebrovascular accidents. In these early studies APSAC appeared to be as effective as streptokinase, as reported in the literature, and to produce a lower incidence of reocclusion than tissue plasminogen activator.