Læknablaðið - 15.09.1986, Blaðsíða 19

LÆKNABLAÐIÐ
197
mestu. Endurtekin meðferð eykur hins vegar
líkurnar á þeim (36).
Aukaverkanir streptókínasameðferðar
verður að skoða í ljósi þess hve alvarlegan
sjúkdóm er verið að meðhöndla og hver
væntanlegur árangur meðferðar er. Fram-
angreind rannsókn bendir til að gagnsemi
streptókínasagjafar við bráða kransæða-
stíflu vegi mun þyngra en hugsanlegt tjón, sé
rétt að verki staðið.
SUMMARY
This article describes the first experience in Iceland with
a high dose intravenous streptokinase therapy in acute
myocardial infarction. Patients had to fulfill the follo-
wing criteria: 1. Less than four hours from onset of
symptoms to beginning of therapy. 2. ST-segment ele-
vation equal or more than 2 mm. 3. No response to
sublingual 0.25 mg nitrglycerine. 4. No contraindication
to thrombolytic therapy. Since November 1983 until end
of 1985 thirty three patients received treatment accor-
ding to this protocol. Two patients were given repeated
treatment. Average time from onset of symptoms to
therapy was 138 minutes. Clinical reperfusion was re-
cognised by: 1. Sudden relief of chest pain during
streptokinase infusion. 2. Lowering of ST segments
within two hours after thrombolytic therapy. 3. An
abrupt increase in CK and CK-MB activity with nadir
within thirteen hours from cessation of streptokinase
infusion. 4. Typical reperfusion arrhythmias and dis-
appearance of conduction defects. According to these
criteria the reperfusion rate was 68%. Coronary angio-
graphy and ventriculography was done in 27 patients on
average 79 days after therapy. The infarct related artery
was patent in 65% of patients with clinical signs of
reperfusion but four (20%) patients in this group had a
reinfarction before angiography. Patients with reperfu-
sion had an average ejection fraction of 60% as com-
pared to 46% in the group without reperfusion
(p<0.05). The systolic motion of the infarct-site myo-
cardium was better in the reperfusion group (p < 0.01),
their vocational ability seemed to be higher (p >0.05) and
there was a tendency for them to be less dependent on
heart failure therapy (p>0.05). Reinfarction occurred
in 8 patients (24%). In five of them this occurred during
the first fourteen days after thrombolytic therapy. Seven
patients (20%) had minor adverse effects from strepto-
kinase therapy and one had various hemorrhages and
died from myocardial rupture.
Although this is not a controlled study and includes
rather few patients the authors conclude that a high dose
intravenous streptokinase therapy is useful in acute
myocardial infarction given due precaution.
ÞAKKARORÐ
Höfundar vilja þakka starfsfólki hjartadeilda Land-
spítalans og Borgarspítalans og lyfjadeildar
Fjórðungssjúkrahússins á Akureyri fyrir framlag þeirra
til rannsóknarinnar. Sérstaklega er Þorkeli Guðbrands
syni yfirlækni þakkað, en hann hafði umsjón með þeim
sjúklingum, sem fengu meðferð á
Fjórðungssjúkrahúsinu á Akureyri. Ottó J. Björnsson
tölfræðingur veitti ráðgjöf varðandi töflur III og IV.
HEIMILDIR
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