Thrombolysis with rt-PA in acute myocardial infarction: no additional benefit of immediate PTCA
(Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty)
1988-01-30
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A randomised trial of 367 patients with acute myocardial infarction was performed to determine whether an invasive strategy combining thrombolysis with recombinant tissue-type plasminogen activator (rTPA), heparin, and acetylsalicylic acid, and immediate percutaneous transluminal coronary angioplasty (PTCA) would be superior to a noninvasive strategy with the same medical treatment but without immediate angiography and PTCA. Intravenous infusion of 100 mg rTPA was started within 5 h after onset of symptoms (median 156 min). Angiography was performed 6-165 min later in 180 out of 183 patients allocated to the invasive strategy; 184 patients were allocated to the non-invasive strategy. Immediate PTCA reduced the percentage stenosis of the infarct-related segment, but this was offset by a high rate of transient (16%) and sustained (7%) reocclusion during the procedure and recurrent ischaemia during the first 24 h (17%). The clinical course was more favourable after non-invasive therapy, with a lower incidence of recurrent ischaemia within 24 h (3%), bleeding complications, hypotension, and ventricular fibrillation. Mortality at 14 days was lower in patients allocated to non-invasive treatment (3%) than in the group allocated to invasive treatment (7%). No difference between the treatment groups was observed in infarct size estimated from myocardial release of alpha-hydroxybutyrate dehydrogenase or in left ventricular ejection fraction after 10-22 days. Since immediate PTCA does not provide additional benefit there seems to be no need for immediate angiography and PTCA in patients with acute myocardial infarction treated with rTPA.
- Male
- Comparative Study
- Human
- Adult
- Aged
- Female
- Combined Modality Therapy
- Middle Aged
- Time Factors
- *Angioplasty, Balloon
- Coronary Angiography
- Europe
- Clinical Trials
- Recurrence
- 9005-49-6 (Heparin)
- Random Allocation
- 0 (Recombinant Proteins)
- 0 (Fibrinolytic Agents)
- Fibrinolytic Agents/administration & dosage/*therapeutic use
- Drug Therapy, Combination
- Infusions, Intravenous
- Tissue Plasminogen Activator/administration & dosage/*therapeutic use
- EC 3.4.21.68 (Tissue Plasminogen Activator)
- 50-78-2 (Aspirin)
- Myocardial Infarction/mortality/*therapy
- Aspirin/administration & dosage/therapeutic use
- Heparin/administration & dosage/therapeutic use
- Recombinant Proteins/administration & dosage/therapeutic use
- patient
- group
- angiography
- infarction
- therapy
- infarct size
- trial
- treatment
- tissue-type plasminogen activator
- study
- 1 patient
- thrombolytic therapy
- stenosi
- reocclusion
- infusion
- infarct
- acetylsalicylic acid
- thrombolysi
- grade
- vessel
