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2012 ; 4
(1
): 7-10
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gab.com Text
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English Wikipedia
Antistreptokinase antibodies and the response to thrombolysis with streptokinase
in patients with acute ST elevation myocardial infarction
#MMPMID27326017
Subhendu MS
; George OK
; Prakash JA
Heart Asia
2012[]; 4
(1
): 7-10
PMID27326017
show ga
BACKGROUND AND OBJECTIVE: A large number of patients with ST elevation myocardial
infarction (STEMI) continue to receive streptokinase (SK) in the developing
countries. High levels of antistreptokinase (ASK) antibodies can result in
failure of thrombolysis. This study was conducted to assess the presence of ASK
antibodies in the general population and its effect on the outcome of
thrombolysis with SK. DESIGN: Prospective observational study. SETTING: A
tertiary care medical institute in Vellore, India. PATIENTS: 148 patients
presenting with STEMI undergoing thrombolysis with SK were recruited. MAIN
OUTCOME MEASURES: The response to SK was assessed by reperfusion markers in the
patients and they were categorised as good responders, probable responders and
non-responders. Those who responded to SK and probable responders were considered
to have benefited from thrombolysis. RESULTS: 60 patients (40%) had ASK antibody
titres higher than the median. In patients with a window period <6?h, 73% of
patients who benefited from thrombolysis had low ASK titres while 100% of the
patients who did not benefit had high ASK titres (p=0.001). Similarly, in
patients with a window period >6?h, 89% of patients who benefited from
thrombolysis had low ASTK titres while 54% of those who did not benefit had high
ASK titres (p=0.002). CONCLUSIONS: ASK antibodies are present in significant
titres in a large proportion of patients in developing countries, which leads to
failure of thrombolysis in such patients. In endemic areas with high endemic
streptococcal infection, alternative agents should be used for thrombolysis in
STEMI.