Estudio Multicentrico Estreptoquinasa Republicas de America del Sur - EMERAS


Late streptokinase thrombolysis for in-hospital mortality in suspected MI.


Patients treated between 6 and 24 hours after onset of symptoms will benefit from streptokinase.

Study Design

Study Design:

Patients Screened: 8,124
Patients Enrolled: 4,534
Mean Follow Up: 1 year
Mean Patient Age: 75: 10%
Female: 23.5

Patient Populations:

Patients presenting 6 to 24 hours after onset of MI symptoms.


History of stroke, gastrointestinal hemorrhage, or stroke within last 3 months.
Severe trauma such as major surgery, head injury, or biopsy within the last 2 months.
Prolonged cardiac massage during previous 24 h.
Persistent severe hypertension, valvulopathy, or cardiomyopathy with atrial fibrillation.
Active pericarditis.
Known allergy to streptokinase, or treatment with streptokinase within last 6 months.
Severe renal or hepatic impairment.
Other life-threatening disease.

Primary Endpoints:

Mortality in hospital
Mortality at the end of the first year

Secondary Endpoints:

Other cardiovascular event

Drug/Procedures Used:

Streptokinase 1.5 MU infused intravenously over about 1 hr in 100 ml saline.

Concomitant Medications:

In original study design, aspirin was to be randomized also; however, published data on benefits of aspirin caused termination of aspirin randomization after 324 patients. Aspirin was recommended for all patients; 82% of streptokinase patients and 83% of placebo patients received aspirin.
Subcutaneous heparin: 13.9% of streptokinase patients, 14.3% of placebo patients
Intravenous heparin: 23.2% of streptokinase patients, 22.2% of placebo patients
Oral anticoagulant: 4.7% of streptokinase patients, 6.2% of placebo patients

Principal Findings:

There was no significant difference in mortality during the hospital stay (11.9% died in streptokinase group, vs 12.4% in placebo group.

Among patients presenting 7-12 hours from symptom onset, there was a non-significant trend toward fewer deaths with streptokinase (11.7% vs. 13.2%) (14% [SD 12] reduction with 95% confidence interval [CI]of 33% reduction to 12% increase).

There was little difference in mortality among patients presenting between 13 and 24 hours (11.4% vs. 10.7%); 8% [SD 16] increase with a 95% CI of 20% reduction to 45% increase.

These 95% CIs are wide and are consistent with the results of previous studies among patients presenting late after symptom onset.


The EMERAS results, though not conclusive on their own, contribute substantially to accumulating evidence on the question of whether late administration of streptokinase produces any worthwhile improvement.


1. Lancet 1993;342:767-72. Final results

Keywords: Thrombolytic Therapy, Hospital Mortality, Streptokinase, Coronary Disease, Length of Stay

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