Evaluation of the level of Antistreptolysin O Antibody in patients with acute myocardial infarction 6 months to 1 year secondary to streptokynase injection

Background and objective:Injection of streptokinase leads to return of circulation in artery in 60% of cases of acute myocardial infarction(AMI). Because of presence of anti-streptolysin O Antibody (ASO), which leads to a reduction in streptokinase efficiency, the safe minimal duration of re-prescribing the drug should be further investigated. Controversy in determining safe minimum-time for re-prescription of streptokinase in different studies is seen. In this study we evaluated the ASO levels in AMI patients 6 months to 1 year after the initial injection in comparison with control group to determine the suitable time gap. Methods and Materials:In this analytical retrospective case-control study a number of 73 patients that had AMI in the past 6 months to 1 year who were treated with streptokinase in Rasul Akram, Firuzgar ,Firuz abadi hospital in 2013-2014 were recruited by non-probable convenience sampling. Patients’ diabetes history, hypertension history, hyperlipidemia, smoking history, and ASO level data was collected from their medical records & the detained blood sample. Patients who had a history of using streptokinase were excluded. The levels of Ab were compared and analyzed using independent sampling t-test and chi-square using SPSS v.24. Findings:A total number of 62 females (41.8%) including 21 AMI patients (33.8%) and 86 males (58.1%) including 52 AMI patients (60.4%) with mean± SD age of 56.79±9.98 in case group and 59.88±11 in control group were studied. Results showed no significant difference between case & control Group in ASO levels P=0.071. Results showed no significant difference between case & control Group regarding mellitus diabetes (17.8% in case group, 25.3% in control group), hypertension(41%in case group, 28% in control group) and pharyngitis(24.6% in case group, 30.6% in control group) P> 0.05. Hyperlipidemia (49% in case group,26.6% in control group) & renal dysfunction had a significantly higher rate in case group p=0.004. There was a significantly higher rate of smoking in case group (44%in case group,14.6% in control group) P<0.001. The result showed no significant difference in ASO level between two groups separated into age groups. There was a significant difference in ASO levels in males and females separately between case and control groups P<0.001. There was a significant difference in ASO levels between males and females in each case and control group (case: male> female, control: female> male) P<0.05.Conclusion: Since no significant difference in ASO levels was observed and ASO is a substitute for streptokinase, according to this study it seems that in case of reoccurrence of AMI 6 months to 1 year after the initial prescription, streptokinase can be prescribed again.

Keywords:

Myocardial infarction (AMI) , Antistreptolysin O (ASO) , Streptokinase