Copyright © 2002 by the European Society of Cardiology.
Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI–SK study
a Thorax Centre, Erasmus University Medical Center, Rotterdam, The Netherlands
b Wojewodski Szpital im. Kniaziewicza, Poland
c Puerta de Hierro, Madrid, Spain
d St Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
e National Institute of Cardiology, Budapest, Hungary
f Knappschafts-Krankenhaus, Recklinghausen, Germany
g Aventis Pharma, Paris, France
revised November 6, 2001; accepted November 7, 2001
Abstract
Aims To establish whether the addition of enoxaparin (a low-molecular-weight heparin) to streptokinase therapy improves early and sustained coronary patency and clinical outcome in patients with evolving myocardial infarction.
Methods and Results A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30mg) and subcutaneous injections (1mg.kg–1, twice daily) of enoxaparin (n=253), or placebo (n=243) for 3–8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90min and 180min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180min was observed in 36%, 44% and 19% in the enoxaparin group vs 25%, 44% and 31% in the placebo group, respectively (P=0·004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70% vs 58%, P=0·01). Combined TIMI-2 and -3 flow was also improved (88% vs 72%, P=0·001), as was TIMI frame count (P=0·003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13% vs 21%, P=0·03).
Conclusion Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5–10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Myocardial infarction, streptokinase, low-molecular-weight heparin, enoxaparin
f1 Correspondence: Prof. dr. M. L. Simoons, Thoraxcentrum, H 560, Erasmus University, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
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