Comparison of intravenous anisoylated plasminogen streptokinase activator complex with intracoronary streptokinase in acute myocardial infarction.

In a randomised trial the efficacy and safety of anisoylated plasminogen streptokinase activator complex (APSAC) administered intravenously and streptokinase administered by intracoronary infusion were compared in patients with proven acute myocardial infarction. Occlusion of the infarct-related vessel, reperfusion and reocclusion were all assessed angiographically. Fibrinolytic therapy was started within 4 (mean 2.4) hours of the onset of symptoms. 85 patients entered the study; 42 were treated with a single intravenous injection of APSAC (30U) given over 3 to 5 minutes and 43 with an intracoronary infusion of streptokinase (250,000U) given over 60 minutes. 12 patients were excluded because of protocol violation. Reperfusion at 90 minutes was confirmed in 23/36 patients (63.9%) in the APSAC group and 25/37 (67.6%) in the streptokinase group; at 24 (+/- 6) hours reocclusion had occurred in 1/22 (4.5%) and 4/23 (13.0%) patients in each group, respectively. These results indicate that APSAC (30U intravenously) is as effective as intracoronary streptokinase (250,000U). The major advantages of APSAC in acute myocardial infarction are its rapid, convenient administration and its low rate of arterial reocclusion.