Acute coronary thrombolysis with recombinant human tissue-type plasminogen activator: initial patency and influence of maintained infusion on reocclusion rate
An intravenous infusion of 40 mg of recombinant tissue-type plasminogen activator (rt-PA) was given intravenously over 90 minutes to 123 patients with acute myocardial infarction (AMI) of less than 4 hours' duration. A coronary angiogram was recorded at the end of the infusion in 119 patients. Central assessment of the angiograms revealed a patent infarct-related artery in 78 patients (patency rate 66%, 95% confidence limits 57 to 74%). Patients with a patent infarct-related artery at the first angiogram were randomized in a double-blind manner to receive a subsequent 6-hour infusion of either 30 mg of rt-PA or placebo. All patients had received an initial bolus of 5,000 IU of heparin and then 1,000 IU/hour until a second angiogram was recorded 6 to 24 hours after the start of the second perfusion. At central assessment of the second coronary angiogram the reocclusion rate was 2 of 36 patients who received rt-PA at the second infusion and 3 of 37 patients not receiving this drug (or the 2 groups combined 7%, 95% confidence limits 2 to 15%). Three of 60 patients (5%, 95% confidence limits 1 to 14%) with patent arteries on both previous angiograms had a later occlusion as judged on the angiogram recorded at hospital discharge. No difference in late reocclusion rates between the 2 treatment groups was observed.
|Keywords||Clinical Trials as Topic, Coronary Angiography, Double-Blind Method, Electrocardiography, Humans, Infusions, Intravenous, Myocardial Infarction/*drug therapy/radiography, Random Allocation, Recombinant Proteins/*therapeutic use, Recurrence, Time Factors, Tissue Plasminogen Activator/administration & dosage/*therapeutic use, Vascular Patency|
|Persistent URL||dx.doi.org/10.1016/0002-9149(87)90219-0, hdl.handle.net/1765/4241|
|Journal||The American Journal of Cardiology|
Verstraete, M, Brower, R.W, Collen, D, de Bone, D.P, de Zwaan, C, Erbel, R, … Arnold, A.E.R. (1987). Acute coronary thrombolysis with recombinant human tissue-type plasminogen activator: initial patency and influence of maintained infusion on reocclusion rate. The American Journal of Cardiology, 60(4), 231–237. doi:10.1016/0002-9149(87)90219-0