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.

Additional Metadata
Keywords *Angioplasty, Balloon, 0 (Fibrinolytic Agents), 0 (Recombinant Proteins), 50-78-2 (Aspirin), 9005-49-6 (Heparin), Adult, Aged, Aspirin/administration & dosage/therapeutic use, Clinical Trials, Combined Modality Therapy, Comparative Study, Coronary Angiography, Drug Therapy, Combination, EC 3.4.21.68 (Tissue Plasminogen Activator), Europe, Female, Fibrinolytic Agents/administration & dosage/*therapeutic use, Heparin/administration & dosage/therapeutic use, Human, Infusions, Intravenous, Male, Middle Aged, Myocardial Infarction/mortality/*therapy, Random Allocation, Recombinant Proteins/administration & dosage/therapeutic use, Recurrence, Time Factors, Tissue Plasminogen Activator/administration & dosage/*therapeutic use
Publisher Elsevier
Persistent URL hdl.handle.net/1765/5368
Citation
Simoons, M.L, Betriu, A, Bokslag, M, de Bono, D.P, Brower, R.W, Col, J.J, … van de Werf, F.J.J. (1988). Thrombolysis with rt-PA in acute myocardial infarction: no additional benefit of immediate PTCA. Elsevier. Retrieved from http://hdl.handle.net/1765/5368