COMPARISON OF FRONT-LOADED RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR, ANISTREPLASE AND COMBINATION THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - RESULTS OF THE THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI) 4 TRIAL

Citation
Cp. Cannon et al., COMPARISON OF FRONT-LOADED RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR, ANISTREPLASE AND COMBINATION THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - RESULTS OF THE THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI) 4 TRIAL, Journal of the American College of Cardiology, 24(7), 1994, pp. 1602-1610
Citations number
50
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System
ISSN journal
0735-1097
Volume
24
Issue
7
Year of publication
1994
Pages
1602 - 1610
Database
ISI
SICI code
0735-1097(1994)24:7<1602:COFRTP>2.0.ZU;2-8
Abstract
Objectives. The aim of our study was to determine a superior thromboly tic regimen from three: anistreplase (APSAC), front-loaded recombinant tissue-type plasminogen activator (rt-PA) or combination thrombolytic therapy. Background. Although thrombolytic therapy has been shown to reduce mortality and morbidity after acute myocardial infarction, it h as not been clear whether more aggressive thrombolytic-antithrombotic regimens could improve the outcome achieved with standard regimens. Me thods. To address this issue, 382 patients with acute myocardial infar ction were randomized to receive in a double blind fashion (along with intravenous heparin and aspirin) APSAC, front-loaded rt-PA or a combi nation of both agents. The primary end point ''unsatisfactory outcome' ' was a composite clinical end point assessed through hospital dischar ge. Results. Patency of the infarct-related artery (Thrombolysis in My ocardial Infarction [TIMI] grade 2 or 3 flow) at 60 min after the star t of thrombolysis was significantly higher in rt-PA-treated patients ( 77.8% vs. 59.5% for APSAC treated patients and 59.3% for combination-t reated patients [rt-PA vs. APSAC, p = 0.02; rt-PA vs, combination, p = 0.03]). At 90 min, the incidence of both infarct-related artery paten cy and TIMI grade 3 flow was significantly higher in rt-PA-treated pat ients (60.2% had TIMI grade 3 how vs. 42.9% and 44.8% of APSAC- and co mbination-treated patients, respectively [rt-PA vs. APSAC, p < 0.01; r t-PA vs. combination, p = 0.02]). The incidence of unsatisfactory outc ome was 41.3% for rt-PA compared with 49% for APSAC and 53.6% for the combination (rt-PA vs. APSAC, p = 0.19; rt PA vs. combination, p = 0.0 6). The mortality rate at 6 weeks was lowest in the rt-PA-treated pati ents (2.2% vs. 8.8% for APSAC and 7.2% for combination thrombolytic th erapy [rt-PA vs. APSAC, p = 0.02; rt-PA vs, combination, p = 0.06]). C onclusions. Front-loaded rt-PA achieved significantly higher rates of early reperfusion and was associated with trends toward better overall clinical benefit and survival than those achieved with a standard thr ombolytic agent or combination thrombolytic therapy. These findings su pport the concept that more rapid reperfusion of the infarct related a rtery is associated with improved clinical outcome.