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Titolo:
EFFECTS OF TISSUE-PLASMINOGEN ACTIVATOR AND A COMPARISON OF EARLY INVASIVE AND CONSERVATIVE STRATEGIES IN UNSTABLE ANGINA AND NON-Q-WAVE MYOCARDIAL-INFARCTION - RESULTS OF THE TIMI IIIB TRIAL
Autore:
BRAUNWALD E; MCCABE CH; CANNON CP; MULLER JE; KNATTERUD G; THOMPSON B; PRIOR MJ; KUFERA J; WILKINS P; GIRO R; RANDALL A; FREDERICK M; CANNER M; DEPKIN J; MONROE L; BELL P; DESVIGNENICKENS P; LETENDRE C; MANN KG; BOVILL E; COLLEN D; TRACY RP; CORNELL E; COLLING CL; PETERSON J; CHAITMAN B; SHAW L; STOCKE K; STONE PH; RUTHERFORD JD; MACCALLUM G; WILLIAMS DO; SHARAF BL; MCKENDALL GR; RILEY RS; THOMAS ES; FERREIRA P; MIELE NJ; ZARET BL; WACKERS FJ; JAIN D; MCMAHON M; THEROUX P; DEGUISE P; JUNEAU M; SEGUIN MA; NASMITH JB; PALISAITIS D; GAUDETTE G; DIVER DJ; BREALL J; BERGER C; BAIM DS; DUNN S; KIRSHENBAUM J; CANNON C; BATESRIORDAN D; HERSON S; DAUM R; CAREY G; MUELLER HS; GOLDBERGER M; GREENBERG MA; MENEGUS MA; VENTURA B; HEMINGWAY K; STEINGART R; GAMBINO A; COGLIANESE ME; BILODEAU S; ROBERTS R; KLEIMAN NS; HABIB G; PULEO P; TRAINOR K; ROSE D; DANGOISSE V; COTE M; DUMAIS B; HARVEY R; GERVAIS A; PROULX G; MIGNAULT JD; ROULEAU JL; PLANTE S; OHARA G; LEPAGE S; DANGOISSE J; LETOURNEAU C; HOCHMAN J; PEPE AJ; WONG SC; BROGUS D; MCANULTY M; THOMPSON CR; WEBB JG; PRIMEAU A; BULLER C; SAUNDERS L; LEYA F; MCKIERNAN T; GRASSMAN E; GALBRAITH E; PICCHI R; WILLERSON JT; ANDERSON HV; WEIGELT LA; SANFORD CF; MURPHY G; SCHWIEGER MJ; PORWAY MN; JOELSON J; PETERMAN M; MARANTZ T; WARWICK D; GIBSON RS; POWERS ER; FAUBER NM; SAYRE SL; BELENKIE I; WARNICA JW; HALL C; CHURCHILLSMITH T; SHOOK TL; MATTHEWS RV; GRAY C; MAHRER PR; JORGENSEN MB; NOCEDA J; MAGORIEN R; EATON G; SHARPWILMER J; BECKER RC; GORE JM; WEINER BH; CORRAO JM; COHEN LS; REMETZ M; MIRTO G; ALEXANDER J; GEGNY A; HAMILTON W; THORNTON T; MAJOR M; BIERMAN K; STONNER T; KRONENBERG MW; CONTI VR; DAVIS MJ; FARRELL RW; NUSYNOWITZ ML; SCHMEDTJE JF; ZWISCHENBERGER JB; IBRAHIM A; PALMERI ST; MOREVRA AE; HOSLER M; CASAZZA L; KELLS CM; ONEILL BJ; FOSTER CJ; FAWCETT T; NEDULCU V; WILLIAMS M; JACKSON M; FELDMAN T; SORRENTINO M; PASTORET A; MCCABE C; BROWN BG; CANNON CD; COHEN LE; RAPAPORT E; CRAWFORD M; GERSTENBLITH G; HARKER LA; SMITH H; TILLEY B; ANDERSON J; TERRIN ML; TOFLER G; SCHERLIS L; BAKER WP; COWLEY M; GUERCI AD; HIRSHFELD JW;
Indirizzi:
BRIGHAM & WOMENS HOSP,DEPT MED,75 FRANCIS ST BOSTON MA 02115 HARVARD UNIV,SCH MED BOSTON MA 00000 MARYLAND MED RES INST BALTIMORE MD 00000 NIH,NATL HEART LUNG & BLOOD INST PROGRAM OFF BETHESDA MD 00000 UNIV VERMONT COLCHESTER VT 00000 VET ADM MED RES SERV ALBUQUERQUE NM 00000 HARVARD UNIV,BRIGHAM & WOMENS HOSP,SCH MED BOSTON MA 02115 RHODE ISL HOSP PROVIDENCE RI 02902 YALE UNIV,SCH MED NEW HAVEN CT 00000 UNIV MONTREAL,MONTREAL HEART INST MONTREAL PQ CANADA HOP SACRE COEUR MONTREAL H4J 1C5 PQ CANADA ALBERT EINSTEIN COLL MED,MONTEFIORE MED CTR BRONX NY 10467 WINTHROP UNIV HOSP MINEOLA NY 11501 BAYLOR COLL MED HOUSTON TX 77030 CHU SHERBROOKE SHERBROOKE PQ CANADA COLUMBIA UNIV,ST LUKES ROOSEVELT HOSP CTR NEW YORK NY 00000 UNIV BRITISH COLUMBIA,ST PAULS HOSP VANCOUVER BC CANADA VANCOUVER GEN HOSP VANCOUVER BC CANADA LOYOLA UNIV,FOSTER MCGAW HOSP,MED CTR MAYWOOD IL 60153 UNIV TEXAS,SCH MED HOUSTON TX 00000 BAYSTATE MED CTR SPRINGFIELD MA 01107 UNIV VIRGINIA,HLTH SCI CTR CHARLOTTESVILLE VA 00000 UNIV CALGARY,FOOTHILLS PROV GEN HOSP CALGARY AB CANADA HOSP GOOD SAMARITAN LOS ANGELES CA 90017 KAISER PERMANENTE MED CTR LOS ANGELES CA 00000 OHIO STATE UNIV COLUMBUS OH 43210 UNIV MASSACHUSETTS,SCH MED WORCESTER MA 00000 YALE UNIV,NEW HAVEN HOSP,SCH MED NEW HAVEN CT 00000 DANBURY HOSP DANBURY CT 00000 ST LOUIS UNIV,MED CTR ST LOUIS MO 00000 UNIV TEXAS,MED BRANCH GALVESTON TX 77550 UNIV MED & DENT NEW JERSEY NEW BRUNSWICK NJ 00000 VICTORIA GEN HOSP HALIFAX B3H 2Y9 NS CANADA UNIV N CAROLINA CHAPEL HILL NC 00000 UNIV CHICAGO HOSP & CLIN CHICAGO IL 00000
Titolo Testata:
Circulation
fascicolo: 4, volume: 89, anno: 1994,
pagine: 1545 - 1556
SICI:
0009-7322(1994)89:4<1545:EOTAAA>2.0.ZU;2-Q
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE CORONARY SYNDROMES; PLACEBO-CONTROLLED TRIAL; THROMBOLYTIC THERAPY; ARTERY DISEASE; DOUBLE-BLIND; INTRAVENOUS STREPTOKINASE; PLATELET ACTIVATION; THROMBIN ACTIVITY; RANDOMIZED TRIAL; ERYTHROCYTE-RICH;
Keywords:
MYOCARDIAL INFARCTION; ANGINA;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
64
Recensione:
Indirizzi per estratti:
Citazione:
E. Braunwald et al., "EFFECTS OF TISSUE-PLASMINOGEN ACTIVATOR AND A COMPARISON OF EARLY INVASIVE AND CONSERVATIVE STRATEGIES IN UNSTABLE ANGINA AND NON-Q-WAVE MYOCARDIAL-INFARCTION - RESULTS OF THE TIMI IIIB TRIAL", Circulation, 89(4), 1994, pp. 1545-1556

Abstract

Background Although coronary thrombosis plays a critical role in the pathogenesis of unstable angina and non-Q-wave myocardial infarction (NQMI), the effects of thrombolytic therapy in these disorders is not clear. Also, the role of routine early coronary arteriography followed by revascularization has not been established. Methods and Results Patients (n=1473) seen within 24 hours of ischemic chest discomfort at rest, considered to represent unstable angina or NQMI, were randomized using a 2x2 factorial design to compare (1) TPA versus placebo as initial therapy and (2) an early invasive strategy (early coronary arteriography followed by revascularization when the anatomy was suitable) versus an early conservative strategy (coronary arteriography followed byrevascularization if initial medical therapy failed). All patients were treated with bed rest, anti-ischemic medications, aspirin, and heparin. The primary end point for the TPA-placebo comparison (death, myocardial infarction, or failure of initial therapy at 6 weeks) occurred in 54.2% of the TPA-treated patients and 55.5% of the placebo-treated patients (P=NS). Fatal and nonfatal myocardial infarction after randomization (reinfarction in NQMI patients) occurred more frequently in TPA-treated patients (7.4%) than in placebo-treated patients (4.9%, P=.04, Kaplan-Meier estimate). Four intracranial hemorrhages occurred in the TPA-treated group versus none in the placebo-treated group (P=.06). The end point for the comparison of the two strategies (death, myocardial infarction, or an unsatisfactory symptom-limited exercise stress test at 6 weeks) occurred in 18.1% of patients assigned to the early conservative strategy and 16.2% of patients assigned to the early invasive strategy (P=NS). In the latter, the average length of initial hospitalization, incidence of rehospitalization within 6 weeks, and days of rehospitalization all were significantly lower. Conclusions In the overall trial, patients with unstable angina and NQMI were managed withlow rates of mortality (2.4%) and myocardial infarction or reinfarction (6.3%) at the time of the 6-week visit. These results can be achieved using either an early conservative or early invasive strategy, the latter resulting in a reduced incidence of days of hospitalization andof rehospitalization and in the use of antianginal drugs. The addition of a thrombolytic agent is not beneficial and may be harmful.

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Documento generato il 29/11/20 alle ore 06:39:31