Background: With respect to the efficacy of thrombolytic agents in the treatment of acute myocardial infarction, the present study was conducted on CCU patients in Shaheed Beheshti hospital in Kashan in 1999-2000. We have determined the efficacy of streptokinase (Sk) based on anti-streptokinase before and after the treatment.

Materials and Methods: For this clinical trial 45 patients with acute myocardial infarction were selected. Their diagnosis was made according to their clinical manifestations as well as EKG and paraclinical studies. Anti-streptokinase was measured by ELISA method. The efficacy of streptokinase was determined by Q wave in EKG.

Results: Of 45 patients, 35 had low and 10 had high level of anti-streptokinase. In 35 patients (28 with low and 10 with high anti-streptokinase) the Q wave remained unchanged following the drug administration. Drug side effects were hypotension (15.5%), bleeding (9%) and allergic reactions (4.5%). No mortality was reported.

Conclusion: With respect to the high prevalence of streptococcal infections in our society, determining the anti-streptokinase level prior to the therapy is recommended. In case of low titer, we suggest streptokinase otherwise other thrombolytic agents should be administered.

Background: Anterior myocardial infarction is relatively a common problem with increasing prevalence. Controversies have arisen regarding the efficacy of streptokinase or magnesium sulfate therapy. The present study was conducted to determine the efficacy of streptokinase, magnesium sulfate and their combination as well as their side effects in patients with anterior acute myocardial infarction, referring to Shaheed Beheshti hospital in Kashan between 1995-97.

Materials and Methods: It was an existing data type study. Diagnosis was made according to the physical exam, history, EKG findings and elevated enzyme level. Patients were assigned in any of the four groups: Routine drug users (Control n=50), routine drug+streptokinase (n=51), routine drug+magnesium sulfate (n=47), routine drug+magnesium sulfate+streptokinase (Group IV n=48). History of previous MI or disabling disease was our exclusion criteria.

Results: The study population included 153 males and 43 females with the mean age of 61.7±10.54 years. Patients were matched according to the age, sex and blood pressure. The mean days of hospitalization were 12.4±2.8 and 8±1.7 in-group IV and control subjects, respectively. For these groups the mean reduction in blood pressure was 52% and 20.8%, respectively (P<0.05). Patients who received streptokinase as well as magnesium have shown lesser side effects (Hemodynamic, mechanical, pericarditis and aneurysm). Death was reported in 12.2% of patients.

Conclusion: It seems as if combination therapy with magnesium sulfate and streptokinase is associated with better outcomes and less side effects.