[Treatment with intracoronary streptokinase in the acute phase of myocardial infarct. Preliminary results apropos of 20 cases].

Twenty patients with primary myocardial infarction (mean age 55 years +/- 6) were treated with intracoronary streptokinase in the acute phase. The mean interval between the onset of chest pain and treatment was 4 hours 30 minutes (extremes, 30 minutes and 6 hours). The total quantity of streptokinase required to obtain coronary revascularisation varied from patient to patient and with the technique used, but it was less than 350,000 units in all cases. The immediate results were favourable in 80 p. 100 of cases with respect to the coronary obstruction, in 50 p. 100 of cases with respect to relief of pain and in 35 p. 100 of cases with respect to ST elevation. It is not possible to confirm the efficacy of this therapy in left ventricular function from the results of this preliminary study. The authors observed, however, that the best results as assessed by 2D echocardiography, left ventricular angiography, and Thallium 201 myocardial scintigraphy were obtained in patients treated early (before the 3rd hour). They emphasise the need to check the level of antistreptokinase antibodies before starting treatment to assess the optimal total dosage for each individual patient, in order to obtain a local effect without disturbing the overall coagulation mechanism.