TY - JOUR
T1 - Anistreplase versus alteplase in acute myocardial infarction
T2 - Comparative effects on left ventricular function, morbidity and 1-day coronary artery patency
AU - Anderson, Jeffrey L.
AU - Becker, Lewis C.
AU - Sorensen, Sherman G.
AU - Karagounis, Labros A.
AU - Browne, Kevin F.
AU - Shah, Prediman K.
AU - Morris, Douglas C.
AU - Fintel, Dan J.
AU - Mueller, Hiltrud S.
AU - Ross, Allan M.
AU - Hall, Suzanne M.
AU - Askins, Jack C.
AU - Doorey, Andrew J.
AU - Grines, Cindy L.
AU - Moreno, Fidela L.
AU - Marder, Victor J.
PY - 1992/10
Y1 - 1992/10
N2 - Objectives. This double-blind, randomized, multicenler trial was designed to compare the effects of treatment with anistreplase (APSAC) and alteplase (rt-PA) on convalescent left ventricular function, morbidity and coronary artery patency at 1 day in patients with acute myocardial infarction. Background. Anistreplase (APSAC) is a new, easily administered thrombolytk agent recently approved for treatment of acute myocardial infarction. Alteplase (rt-PA) is a rapidly acting, relatively fibrin-specific thrombolytic agent that is currently the most widely used agent in the United States. Methods. Study entry requirements were age ≤ 75 years, symptom duration ≤ 4 h, ST segment elevation and no contraindications. The two study drugs, APSAC, 30 U/2 to S min, and rt-PA, 100 mg/3 h, were each given with aspirin (160 mg/day) and intravenous heparin. Prespecified end points were convalescent left ventrkular function (rest/exercise), clinical morbidity and coronary artery patency at 1 day. A total of 325 patients were entered, stratified into groups with anterior (37%) or inferior or other (63%) acute myocardial infarction, randomized to receive APSAC or rt-PA and followed up for 1 month. Results. At entry, patient characteristics in the two groups were balanced. Convalescent ejection fraction at the predischarge study averaged 51.3% in the APSAC group and 54.2% in the rt-PA group (p < 0.05); at 1 month, ejection fraction averaged 50.2% versus 54.8%, respectively (p < 0.61). In contrast, ejection fraction showed similar augmentation with exercise at 1 month after APSAC (+4.3% points) and rt-PA (+4.6% points), and exercise times were comparable. Coronary artery patency at 1 day was high and similar in berth groups (APSAC 89%, rt-PA 86%). Mortality (APSAC 6.2%, rt-PA 7.9%) and the incidence of other serious clinical events, including stroke, ventricular tachycardia, ventricular fibrillation, heart failure within 1 month, recurrent ischemia and reinfarelion were comparable in the two groups; and mechanical interventions were applied with equal frequency. A combined clinical morbidity index was determined and showed a comparable overall outcome for the two treatments. Conclusions. Convalescent rest ejection fraction was high after both therapies but higher after rt-PA; other clinical outcomes, including exercise function, morbidity index, and 1-day coronary artery patency, were favorable and comparable after APSAC and rt-PA.
AB - Objectives. This double-blind, randomized, multicenler trial was designed to compare the effects of treatment with anistreplase (APSAC) and alteplase (rt-PA) on convalescent left ventricular function, morbidity and coronary artery patency at 1 day in patients with acute myocardial infarction. Background. Anistreplase (APSAC) is a new, easily administered thrombolytk agent recently approved for treatment of acute myocardial infarction. Alteplase (rt-PA) is a rapidly acting, relatively fibrin-specific thrombolytic agent that is currently the most widely used agent in the United States. Methods. Study entry requirements were age ≤ 75 years, symptom duration ≤ 4 h, ST segment elevation and no contraindications. The two study drugs, APSAC, 30 U/2 to S min, and rt-PA, 100 mg/3 h, were each given with aspirin (160 mg/day) and intravenous heparin. Prespecified end points were convalescent left ventrkular function (rest/exercise), clinical morbidity and coronary artery patency at 1 day. A total of 325 patients were entered, stratified into groups with anterior (37%) or inferior or other (63%) acute myocardial infarction, randomized to receive APSAC or rt-PA and followed up for 1 month. Results. At entry, patient characteristics in the two groups were balanced. Convalescent ejection fraction at the predischarge study averaged 51.3% in the APSAC group and 54.2% in the rt-PA group (p < 0.05); at 1 month, ejection fraction averaged 50.2% versus 54.8%, respectively (p < 0.61). In contrast, ejection fraction showed similar augmentation with exercise at 1 month after APSAC (+4.3% points) and rt-PA (+4.6% points), and exercise times were comparable. Coronary artery patency at 1 day was high and similar in berth groups (APSAC 89%, rt-PA 86%). Mortality (APSAC 6.2%, rt-PA 7.9%) and the incidence of other serious clinical events, including stroke, ventricular tachycardia, ventricular fibrillation, heart failure within 1 month, recurrent ischemia and reinfarelion were comparable in the two groups; and mechanical interventions were applied with equal frequency. A combined clinical morbidity index was determined and showed a comparable overall outcome for the two treatments. Conclusions. Convalescent rest ejection fraction was high after both therapies but higher after rt-PA; other clinical outcomes, including exercise function, morbidity index, and 1-day coronary artery patency, were favorable and comparable after APSAC and rt-PA.
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U2 - 10.1016/0735-1097(92)90170-R
DO - 10.1016/0735-1097(92)90170-R
M3 - Article
C2 - 1527286
AN - SCOPUS:0026485439
SN - 0735-1097
VL - 20
SP - 753
EP - 766
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -