The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction

Tissue plasminogen activator (t-PA) may restore coronary blood flow and ventricle function after heart attack faster than streptokinase or both in combination. T-PA and streptokinase are thrombolytic drugs which destroy clots that obstruct blood flow. Four combinations of t-PA, streptokinase or both were randomly assigned to 2,431 patients along with heparin, an anticoagulant. Researchers performed angiograms at 90 min, 180 min, 24 hours and five to seven days after therapy. Fifty-four percent of the t-PA and heparin group had normal blood flow at 90 min. Less than 40% of the three remaining groups had restored flow by the first angiogram. The t-PA group and patients with normal blood flow had the best ventricular function after treatment. At 180 min, angiograms showed no blood flow differences between the treatment groups. T-PA patients had the lowest death rates of all four groups 30 days after treatment, which may have resulted from early flow restoration.