Background In patients with acute ischemic stroke, early treatmentwith thrombolytic agents is thought to permit reperfusion ofischemic neurons and to promote recovery of function. The MulticenterAcute Stroke Trial — Europe (MAST-E) was designed to assessthe efficacy and safety of streptokinase in patients with acuteischemic stroke.
Methods Patients with moderate-to-severe ischemia in the territoryof the middle cerebral artery were randomly assigned to receivestreptokinase (1.5 million units over a period of one hour)or placebo within six hours after the onset of stroke. The primaryefficacy outcome was a binary criterion combining mortalityand severe disability at six months, with severe disabilitydefined as a score of 3 or higher on the Rankin scale. The primarysafety outcomes were mortality at 10 days and cerebral hemorrhage.
Results All randomized patients (156 in the streptokinase groupand 154 in the placebo group) were evaluated at six months.The incidence of the primary efficacy outcome was similar inthe two groups (124 patients in the streptokinase group and126 in the placebo group died or had a Rankin score >3).However, the mortality rate at 10 days was significantly higherin the streptokinase group than in the placebo group (34.0 percentvs. 18.2 percent, P = 0.002). The higher rate in the streptokinasegroup was mainly due to the hemorrhagic transformation of ischemiccerebral infarcts. At six months, more deaths had occurred inthe streptokinase group than in the placebo group (73 vs. 59,P = 0.06).
Conclusions In patients with acute ischemic stroke, treatmentwith streptokinase resulted in an increase in mortality. Theroutine use of streptokinase cannot be recommended in acuteischemic stroke.
Source Information
Address reprint requests to Dr. Marc Hommel, Stroke Unit, Clinique Neurologique, Centre Hospitalier Universitaire de Grenoble, B.P. 217, 38043 Grenoble CEDEX 9, France.
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