Comparison of Tissue Plasminogen Activator and Streptokinase in the Management of Acute Myocardial Infarction

¹ The Cardiology Department, Green Lane Hospital, Auckland, New Zealand.

The available data do not support the concept that either agent is clearly superior in overall clinical benefit. Each drug has certain theoretical advantages that may or may not prove to be clinically relevant. One drug may have an advantage in a particular clinical situation. If readministration of a thrombolytic agent is necessary between 5 days and 3 months after initial administration, tPA activator would be the drug of choice. Tissue plasminogen activator may also be preferred if the patient is in cardiogenic shock, in which mortality exceeds 70%. The probable lytic advantage of tPA in opening the artery as fast as possible could be an advantage in saving lives in this situation. The possible advantages of streptokinase in modifying the healing phase of infarction may be important for patients presenting late, when achievement of coronary artery patency is unlikely to salvage myocardium. Streptokinase also may be preferred if acute angioplasty is being considered because of the possibility of less reocclusion when angioplasty follows the use of this agent. Our comparative data for preservation of LV function will soon be available, and this trial will complement the large randomized mortality trials that will also be addressing the important question of the relative frequency of adverse effects with each agent.