Comparison of Effects of Streptase and Heberkinasa in Treatment of Acute ST Elevation Myocardial Infarction (STEMI)

I
 
 





ntroduction:Streptokinase (SK) is the most widely used thrombolytic agent in treatment of acute STEMI in our country. Recent studies have showed the poor quality of SK products in use in the developing countries.
 
 
 
Materials and Methods: this clinical trial study was performed between 2005 and 2006 at Ghaem and Javad-al-Aemeh Hospitals of Mashhad and Shariati Hospital of Fasaa. Two hundred sixty thrombolytic eligible acute STEMI patients were randomly assigned to Streptase, produced in Germany (group I; n=130) or Heberkinasa, produced in Cuba (group II; n=130).Dose of drugs was 1,500,000 units administrated in 60 minutes. Response to treatment were assessed by clinical (angina, re-MI, heart failure, mortality), laboratory (CK_MB), electrocardigraphy (resolution of ST elevation, arrhythmia) and echocardiographical (LVEF, MR) parameters .All data were analyzed by the SPSS version 11 and comparison between the treatment groups was performed using the chi-square and Z-test.
 
 
Results: the patients in two groups were similar in age, sex, risk factors, site of MI and killip class. More than 50% decline in the sum of ST elevation was observed in 76.9% of group I and 53.1% of group II, (p=0.000). Peak of CKMB at 6^thhour was higher in group I than II, 70.8% vs 60%, (p=0.01). Occurrence of re-MI was not significantly different, 1.53% vs 0.76% (p=0.56). Superiority of Streptase to Heberkinasa was shown also in the rate of pulmonary edema, 9.2% vs 19.2% (p=0.02) and cardiogenic shock, 6.9% vs 19.2% (p=0.003). Mean LVEF was higher in group I, 50.8% vs 40.5% (p=0.0001) and significant MR (mitral regurgitation) was lower, 3.3% vs 8.3% (p=0.03). Mortality rate wasn't different in two groups.
 
Conclusion: According to clinical and Paraclinical parameters streptase was significantly more effective than Heberkinasa in the treatment of patients with acute STEMI.