RELATIONSHIP BETWEEN FIBRINOLYTIC-ACTIVITY FOLLOWING STREPTOKINASE TREATMENT IN ACUTE MYOCARDIAL-INFARCTION AND VECTORCARDIOGRAPHIC SIGNS OF REPERFUSION

The aim of the study was to examine the fibrinolytic response in patie nts with acute myocardial infarction (AMI) treated with streptokinase (SK) and relate this to vectorcardiographic signs of successful reperf usion or persistent ischaemia. Umea University Hospital, a referral ce ntre for northern Sweden, was the setting and 40 consecutive patients with AMI who were treated with SK, 25 patients with AMI who were not g iven thrombolytic agents and 10 patients with chest pain who did not d evelop AMI were studied. PAI-1 activity and PAI-1 mass concentration, amidolytic activity and tPA mass concentration, as well as von Willebr and factor (VWF) at admission and in serial samples up to 6 weeks late r, were measured. Computerized on-line vectorcardiography (VCG) was us ed for continuous ischaemia monitoring during the first 24 h after adm ission to the coronary care unit (CCU) in order to identify patients w ith successful reperfusion. In patients with AMI, those treated with S K showed significant increases during the first 2 days in all the stud ied fibrinolytic variables and vWF, while this was not seen in the AMI group not treated with SK. The non-AMI chest pain group displayed no changes over time in any studied variable. SK-treated AMI patients dev eloped high peak levels of amidolytic activity after 4 and 10 h, but t his was not found in either of the control groups. Successful reperfus ion was associated with amidolytic-activity values of > 30 U/mL within 10 h (P< 0.05). The SK treatment of AMI induced profound changes in t he fibrinolytic system and vWF. High peak levels and the early onset o f amidolytic activity were associated with successful reperfusion.