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[Thrombolytic therapy for acute myocardial infarction: circadian sensitivity].

AIM
To identify additional factors which may influence the results of thrombolytic therapy (TT) with streptokinase in acute myocardial infarction (AMI).


MATERIALS AND METHODS
122 case histories of males treated with streptokinase for AMI were analyzed. The patients were subdivided into 3 groups according to TT effectiveness: effective (74 patients-60.7%, age 61.3 +/- 11.9 years, group 1); probably successful (13 patients-10.7%, age 68.9 +/- 9.3, group 2), unsuccessful (35 patients-28.6%, age 64.9 +/- 13.6, group 3).


RESULTS
Between groups 1 and 3 there were no differences by age, AMI location, coronary risk factors (smoking, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary disease), previous MI, Q and non-Q-wave MI prevalence. Significant differences were, on the contrary, obtained for the Killip class (1.82 +/- 0.46 vs 2.26 +/- 0.74, p = 0.0001), fibrinogen level before TT (314.6 +/- 87.2 vs 215.5 +/- 121.9 mg%, p = 0.003), LVEF% (by echo) 24 hours after the treatment (41.9 +/- 6.3 vs 36.5 +/- 7.8, p = 0.0001), time delay of TT from AMI symptoms onset (2.45 +/- 1.14 vs 3.08 +/- 1.73 hours, p = 0.014). Circadian variation has been discovered for efficacy of streptokinase: in the evening (from 16 to 24 pm) the effectiveness of TT was highest--38.0% vs 14.7% (p = 0.005) and at night (from 24 pm to 08 am) the effect was the lowest--22.5% vs 41.2% (p = 0.024). Smoking was not an independent factor for TT success.


CONCLUSION
Multiple regression analysis (step by step) has shown that the main independent determinants for TT success in males were: Killip class (p = 0.002), time delay of TT (p = 0.014), day time of TT beginning (p = 0.023) and MI location (p = 0.123). These findings may have several clinical implications, for example: dose adjustment of streptokinase for the time of day or preference for primary coronary angioplasty in the morning.