AsianScientist (May 27, 2011) – In patients suffering from a heart attack, thrombolysis (dissolving the arterial clot) is one of the medical options available. This involves the use of a recombinant tissue plasminogen activator (rTPA) such as streptokinase which is secreted by several strains of Streptococcus bacteria.
Although streptokinase is much cheaper, it has a higher risk of allergic reactions and also lower efficacy, due to antibodies circulating within an individual’s blood from previous Group A Streptococcus infections which are quite common.
In a new study published in the British Medical Journal Clinical Pathology, a team led by Dr. Gary Nixon at the University of Otago has shown that indigenous people with acute coronary syndromes are more likely to have resistance to the standard heart drug streptokinase.
180 participants from the Hokianga, Thames, and Central Otago regions who were admitted to hospital with a suspected heart attack were selected for the study.
The researchers discovered that patients in Hokianga, the rural community with the highest proportion of Maori and the lowest socioeconomic status, were 2.8 times more likely to be resistant to streptokinase than the patient population in Central Otago, which had the lowest proportion of Maori and a higher socioeconomic status.
The reason behind this difference is the high endemic levels of Group A Streptococcus infection, associated with rheumatic fever, in lower socioeconomic communities.
Several countries including Samoa, the Cook islands, French Polynesia, and Tonga have some of the world’s highest incidences of rheumatic fever. Furthermore, Pacific Islanders living in New Zealand have an incidence of rheumatic fever which is up to two times that of the Maori. It is postulated that all these areas would have an increased resistance to Streptokinase as well.
Dr. Nixon says these very significant differences mean that newer fibrinolytic heart drugs should be used for patients with heart attacks in predominantly Maori rural communities. However, he says these fibrinolytic agents, which are not affected by the immune system, are more expensive than streptokinase, reducing their widespread use.
The article can be found at: Nixon G et al. (2011) Streptokinase antibodies in patients presenting with acute coronary syndrome in three rural New Zealand populations.
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Source: Journal of Clinical Pathology.
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