Circulation, Vol 75, 420-428, Copyright © 1987 by American Heart Association
EJ Topol, WW O'Neill, AB Langburd, JA Walton Jr, PD Bourdillon, ER Bates, CL Grines, AM Schork, E Kline and B Pitt
To determine the role of tissue-type plasminogen activator (t-PA) and
immediate percutaneous transluminal coronary angioplasty (PTCA) in treating
patients with evolving transmural myocardial infarction, 50 patients
received t-PA (1.25 mg/kg iv over 3 hrs) or placebo according to 3:1
double-blind randomization 3.8 +/- 1.1 hr after onset of symptoms. At
emergency coronary arteriography, patency of the infarct- related vessel
was demonstrated in 32 of 38 (84%) patients receiving t- PA vs two of 12
(17%) receiving placebo (p less than .001). Of the 32 patients with
recanalization after t-PA, 28 had a residual stenosis of at least 50% and
underwent randomization a second time to immediate (n = 15) or no PTCA (n =
13). Immediate PTCA of the infarct-related vessel was successful in all 15
patients, with reduction of the residual diameter stenosis from 80.8 +/-
8.2% to 32.5 +/- 15.6% (p less than .001). The incidence of postinfarction
angina (greater than or equal to 20 min of chest discomfort and reversible
electrocardiographic changes) and reinfarction (documented by recurrent
creatine kinase isoenzyme elevation) was reduced in the patients receiving
t-PA and PTCA (2/15) compared with that in patients receiving t-PA alone
(7/13; p = .006). At 1 week there was no difference in patency of the
infarct-related vessel (12/15 t-PA and PTCA vs 9/13 t-PA only) or in global
ventricular functional change between the two groups (0.5 +/- 10.4 SD/chord
for t- PA and PTCA vs -2.1 +/- 8.2 SD/chord for t-PA only).(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
A randomized, placebo-controlled trial of intravenous recombinant tissue-type plasminogen activator and emergency coronary angioplasty in patients with acute myocardial infarction
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