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Western Washington Randomized Trial of Intracoronary Streptokinase in Acute Myocardial Infarction

List of authors.
  • J. Ward Kennedy, M.D.,
  • James L. Ritchie, M.D.,
  • Kathryn B. Davis, Ph.D.,
  • and James K. Fritz, M.D.

Abstract

Two hundred fifty patients were enrolled in a multicenter, community-based study of the efficacy of intracoronary streptokinase thrombolysis in acute myocardial infarction; 134 were randomly assigned to streptokinase therapy and 116 were controls. All patients underwent left ventricular angiography and coronary arteriography before the random assignment.

The mean time from the onset of symptoms to hospitalizaron was 134±144 minutes (S.D), and the mean time to random assignment was 276±185 minutes. Coronary reperfusion was achieved in 68 per cent of the streptokinase-treated group. The overall 30-day mortality was 18 (7.2 per cent); there were five deaths in the streptokinase-treated group (3.7 per cent) and 13 in the control group (11.2 per cent, P<0.02). Fifteen of the 18 deaths occurred in patients with anterior infarction.

Intracoronary streptokinase therapy resulted in a nearly threefold reduction in the 30-day mortality after hospitalization for acute myocardial infarction. (N Engl J Med 1983; 309:1477–82.)

Funding and Disclosures

Supported in part by the W.M. Keck Foundation and the Medical Research Service of the Veterans Administration.

The principal investigators and their associates of the Western Washington Intracoronary Streptokinase Trial: J. Ward Kennedy, M.D., Director, James L. Ritchie, M.D., Co-Director, Kathryn B. Davis, Ph.D., Investigator, James K. Fritz, M.D., Investigator; Data Coordinating Center: Kathryn B. Davis, Ph.D., Charles Maynard, M.A., David Fray, B.A.; Policy Board: Simeon Rubenstein, M.D., Chairman, Paul B. Beeson, M.D., Thomas S. Inui, M.D., Lloyd D. Fisher, Ph.D.; Consultants; K. Lance Gould, M.D., Houston, Texas, William Ganz, M.D., Los Angeles, Calif., Harold T. Dodge, M.D., Seattle, Wash., Robert A. Bruce, M.D., Seattle, Wash., Marie Cowan, R.N., Ph.D., Seattle, Wash.; Technicians: Carol Alcock, Ann Coleman, Kay Gaines; Nurses: Dee Erickson, R.N., Kathleen McFadden, R.N.; Clinical Associates: Overlake Hospital, Bellevue Wash., C.E. Hansing, K.M. Hynes, R.E. Haynes, D.B. Ferrin, J.S. Schneider (Ken Kyles, Randy Swartz); St. Joseph Hospital, Bellingham, Wash., R.S. Trenouth, D.C. Brown, D.D. McAfee (Susan Harris); Everett General Hospital, Everett, Wash., J.P. Nolan, D.J. Stewart, W.J. MacDonald, K.H. Prindle, N.D. Smith, J. Schmitt (Linda Woucha, Harlan Jones); Providence Hospital, Seattle, Wash., G.A. Logan, F.M. Tobis, T.A. Block, J.G. Doces, M.T. English, P.C. Albro, A.L. Sytman, R.A. Crone, C.G. Hale, B. Green (Pat Jordan); Swedish Hospital, Seattle, Wash., F.A. Short, W.E. Samson, R.J. Westcott, J.L. Peterson (Linda Gorborino); University Hospital, Seattle, Wash., D.K. Stewart, J.A. Murray, K.F. Hossack, J.A. Werner, G. Frank, G.B. Brown, D.W. Weaver, G.B. Trobaugh (Royce Snyder); Veterans Administration Hospital, Seattle, Wash., J.W. Kennedy, J.L. Ritchie, J.H. Caldwell, J. Stratton (Carol Alcock) Virginia Mason Hospital, Seattle, Wash., R.R. Johnston, (Mary A. Madsen); Madigan Army Hospital, Tacoma, Wash., J.L. Hill T. Steudel. R. Chamusco (Don Felton, Pearl C. Jakeman); Tacoma General Hospital, Tacoma, Wash., E. Lapin, T. Reagan (John Viles); St. Joseph's Hospital, Tacoma, Wash., J.R. McDonough, M. Henry (Tom Samon); Vancouver General Hospital, Vancouver, B.C., R.R. Ricci; Wenatchee Valley Hospital, Wenatchee, Wash., D. Larson, J. Gorham (Larry Keyser); St. Elizabeth Hospital, Yakima, Wash., P.A. Monick, R.D. Twiss, A.B. Preacher, R.K. Spiegel (Frances Braunagel, Mark Rupert).

The physicians whose names are underlined were administratively responsible for the trial at their institutions. In parentheses are listed the catheterization laboratory technicians responsible for the study.

Author Affiliations

From the Division of Cardiology and the Department of Biostatistics, University of Washington School of Medicine and the Seattle Veterans Administration Medical Center, Seattle. Address reprint requests to Dr. Kennedy at the Division of Cardiology, RG-20, University Hospital, Seattle, WA 98195.

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