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Titolo:
COMPARISON OF FRONT-LOADED RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR, ANISTREPLASE AND COMBINATION THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - RESULTS OF THE THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI) 4 TRIAL
Autore:
CANNON CP; MCCABE CH; DIVER DJ; HERSON S; GREENE RM; SHAH PK; SEQUEIRA RF; LEYA F; KIRSHENBAUM JM; MAGORIEN RD; PALMERI ST; DAVIS V; GIBSON CM; POOLE WK; BRAUNWALD E; PULEO P; ABENDSCHEIN D; LOSCALZO J; CHAITMAN BR; ZARET BL; DANGOISSE V; FLAKER GC; GARRISON TW; SCHWEIGER MJ; MAHRER PR; SHOOK TL; ANDERSON JL; PALISAITIS D; COHN PF; LARAMEE LA;
Indirizzi:
BRIGHAM & WOMENS HOSP,DEPT MED,DIV CARDIOL,75 FRANCIS ST BOSTON MA 02115 BRIGHAM & WOMENS HOSP,DEPT MED,DIV CARDIOL BOSTON MA 02115 HARVARD UNIV,SCH MED,DIV CARDIOL BOSTON MA 00000 EMERSON HOSP CONCORD MA 00000 ALTA BATES MED CTR BERKELEY CA 00000 CEDARS SINAI MED CTR LOS ANGELES CA 90048 LOYOLA UNIV HOSP MAYWOOD IL 00000 OHIO STATE UNIV COLUMBUS OH 43210 UNIV MED & DENT NEW JERSEY NEW BRUNSWICK NJ 00000 RES TRIANGLE INST RES TRIANGLE PK NC 27709 BETH ISRAEL HOSP BOSTON MA 02215 BAYLOR COLL MED,METHODIST HOSP HOUSTON TX 77030 VET ADM MED CTR,COOPERAT STUDIES PROGRAM,CLIN RES PHARM COORDINATING CTR ALBUQUERQUE NM 00000 ST LOUIS UNIV ST LOUIS MO 63103 YALE UNIV,SCH MED NEW HAVEN CT 00000 UNIV MIAMI,JACKSON MEM HOSP MIAMI FL 33136 UNIV SHERBROOKE,CTR HOSP SHERBROOKE J1K 2R1 PQ CANADA UNIV MISSOURI COLUMBIA MO 00000 BAYSTATE MED CTR SPRINGFIELD MA 01107 KAISER PERMANENTE MED CTR LOS ANGELES CA 00000 HOSP GOOD SAMARITAN LOS ANGELES CA 90017 UNIV UTAH,LATTER DAY ST HOSP SALT LAKE CITY UT 84143 HOP SACRE COEUR MONTREAL H4J 1C5 PQ CANADA SUNY STONY BROOK,HLTH SCI CTR STONY BROOK NY 11794 UNIV OTTAWA,INST HEART OTTAWA ON CANADA
Titolo Testata:
Journal of the American College of Cardiology
fascicolo: 7, volume: 24, anno: 1994,
pagine: 1602 - 1610
SICI:
0735-1097(1994)24:7<1602:COFRTP>2.0.ZU;2-8
Fonte:
ISI
Lingua:
ENG
Soggetto:
LEFT-VENTRICULAR FUNCTION; 12-MONTH FOLLOW-UP; RANDOMIZED TRIAL; ELECTROCARDIOGRAPHIC EVIDENCE; INTRACORONARY STREPTOKINASE; SUCCESSFUL REPERFUSION; PERFUSION STATUS; CORONARY-ARTERY; CLINICAL-TRIALS; END-POINT;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
50
Recensione:
Indirizzi per estratti:
Citazione:
C.P. Cannon et al., "COMPARISON OF FRONT-LOADED RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR, ANISTREPLASE AND COMBINATION THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - RESULTS OF THE THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI) 4 TRIAL", Journal of the American College of Cardiology, 24(7), 1994, pp. 1602-1610

Abstract

Objectives. The aim of our study was to determine a superior thrombolytic regimen from three: anistreplase (APSAC), front-loaded recombinant tissue-type plasminogen activator (rt-PA) or combination thrombolytic therapy. Background. Although thrombolytic therapy has been shown toreduce mortality and morbidity after acute myocardial infarction, it has not been clear whether more aggressive thrombolytic-antithromboticregimens could improve the outcome achieved with standard regimens. Methods. To address this issue, 382 patients with acute myocardial infarction were randomized to receive in a double blind fashion (along with intravenous heparin and aspirin) APSAC, front-loaded rt-PA or a combination of both agents. The primary end point ''unsatisfactory outcome'' was a composite clinical end point assessed through hospital discharge. Results. Patency of the infarct-related artery (Thrombolysis in Myocardial Infarction [TIMI] grade 2 or 3 flow) at 60 min after the start of thrombolysis was significantly higher in rt-PA-treated patients (77.8% vs. 59.5% for APSAC treated patients and 59.3% for combination-treated patients [rt-PA vs. APSAC, p = 0.02; rt-PA vs, combination, p = 0.03]). At 90 min, the incidence of both infarct-related artery patency and TIMI grade 3 flow was significantly higher in rt-PA-treated patients (60.2% had TIMI grade 3 how vs. 42.9% and 44.8% of APSAC- and combination-treated patients, respectively [rt-PA vs. APSAC, p < 0.01; rt-PA vs. combination, p = 0.02]). The incidence of unsatisfactory outcome was 41.3% for rt-PA compared with 49% for APSAC and 53.6% for thecombination (rt-PA vs. APSAC, p = 0.19; rt PA vs. combination, p = 0.06). The mortality rate at 6 weeks was lowest in the rt-PA-treated patients (2.2% vs. 8.8% for APSAC and 7.2% for combination thrombolytic therapy [rt-PA vs. APSAC, p = 0.02; rt-PA vs, combination, p = 0.06]). Conclusions. Front-loaded rt-PA achieved significantly higher rates ofearly reperfusion and was associated with trends toward better overall clinical benefit and survival than those achieved with a standard thrombolytic agent or combination thrombolytic therapy. These findings support the concept that more rapid reperfusion of the infarct related artery is associated with improved clinical outcome.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/12/20 alle ore 10:40:45