OCCURRENCE OF HYPOTENSION DURING STREPTOKINASE INFUSION IN SUSPECTED ACUTE MYOCARDIAL-INFARCTION, AND ITS RELATION TO PROGNOSIS AND METOPROLOL THERAPY

In all patients who received streptokinase infusion for strongly suspe cted acute myocardial infarction in 1 hospital during 1989 to 1990, th e occurrence of hypotension during infusion is described and related t o prognosis. In 54% of patients, the beta blocker metoprolol was simul taneously administered intravenously. The median systolic blood pressu re (BP) before infusion was 135 mm Hg, and the median value for the lo west systolic BP recorded during infusion was 100 mm Hg (p <0.001). A positive correlation between systolic BP before streptokinase and the lowest systolic BP during infusion was found (r = 0.53; p <0.001). Amo ng patients administered streptokinase and metoprolol, 23% had systoli c BP <90 mm Hg, and 12% had <80 mm Hg at any time during infusion; cor responding values for patients administered streptokinase only were 47 and 30%, respectively. Patients with the lowest systolic BP <80 mm Hg during infusion had a mortality during the first 2 weeks of 22 vs 11% for those with between 80 and 100 mm Hg, and 8% for those with >100 m m Hg (p <0.001). However, in a multivariate analysis the systolic BP b efore infusion rather than the lowest systolic BP during infusion was independently associated with death. It is concluded that although pat ients with low systolic BP during streptokinase infusion have a high m ortality, the level of systolic BP before infusion is more strongly as sociated with the outcome. Simultaneous use of intravenous beta blocka de does not increase the occurrence of hypotension during streptokinas e infusion.