Journal of Research in Medical Sciences 2004, 4: 22-26
Shemirani,H.; Tajmirriahi,M.; Rezaei,A.; Oreisi,F.
Background: The risk for unsuccessful reperfusion after streptokinase therapy
may be caused by the antifibrinolytic effect of platelet-derived type 1 plasminogen activator inhibitor
(Pal-1) and antistreptokinase antibodies. This study aims to show the relation of pretreatment PAI-1 levels
of patients with acute myocardial infarction treated with streptokinase and the outcome of fibrinolysis,
emphasizing on reperfusion with and without considering pretreatment antistreptokinase antibodies.
Methods: Pretreatment PAI-1 and antistreptokinase antibodies levels of 61
patients with acute myocardial infarction, treated with streptokinase, were determined by an enzyme-linked
immunosorbent assay kit method. Failure of thrombolysis with streptokinase was present when reperfusion
was unsuccessful as assessed by noninvasive reperfusion criteria.
Results: Mean pretreatment PAI-1 level of patients was 29.72 ± 4.74 ng/ml.
Thrombolysis with streptokinase failed significantly with higher pretreatment PAI-1 levels (p < 0.05) in all
patients and patients with negative pretreatment antistreptokinase antibodies.
Conclusion: We showed that higher on reperfusion in patients with acute
myocardial infarction, with and without considering pretreatment antistreptokinase pretreatment PAI-1 levels
were associated with significant failure of streptokinase therapy with the emphasis antibodies (anti-SK).
It seems that by estimating PAI-1>25ng/l and antistreptokinase antibodies higher than normal levels in
patients before the start of streptokinase therapy, candidates for potentially unsuccessful streptokinase
therapy (with failed reperfusion) can be identified in advance and an alternative therapy such as primary
angioplasty with better immediate results can be started.