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Title: Low-Dose Alteplase During Primary Percutaneous Coronary Intervention According to Ischemic Time
Authors: Ford, Tom ;McCartney, P.J.;Maznyczka, A.M.;Eteiba, H.;McEntegart, M.;Oldroyd, K.G.;Greenwood, J.P.;Maredia, N.;Schmitt, M.;McCann, G.P.;Fairbairn, T.;McAlindon, E.;Tait, C.;Welsh, P.;Sattar, N.;Orchard, V.;Corcoran, D.;Radjenovic, A.;McConnachie, A.;Berry, C.
Affliation: Central Coast Local Health District
Gosford Hospital
Issue Date: Mar-2020
Source: 75(12):1406-1421
Journal title: Journal of the American College of Cardiology
Department: Cardiology
Abstract: BACKGROUND: Microvascular obstruction affects one-half of patients with ST-segment elevation myocardial infarction and confers an adverse prognosis. OBJECTIVES: This study aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intracoronary alteplase infused early after coronary reperfusion associates with ischemic time. METHODS: This study was conducted in a prospective, multicenter, parallel group, 1:1:1 randomized, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified subgroup of interest. Between March 17, 2016, and December 21, 2017, 440 patients, presenting with ST-segment elevation myocardial infarction within 6 h of symptom onset (<2 h, n = 107; >/=2 h but <4 h, n = 235; >/=4 h to 6 h, n = 98), were enrolled at 11 U.K. hospitals. Participants were randomly assigned to treatment with placebo (n = 151), alteplase 10 mg (n = 144), or alteplase 20 mg (n = 145). The primary outcome was the amount of microvascular obstruction (MVO) (percentage of left ventricular mass) quantified by cardiac magnetic resonance imaging at 2 to 7 days (available for 396 of 440). RESULTS: Overall, there was no association between alteplase dose and the extent of MVO (p for trend = 0.128). However, in patients with an ischemic time >/=4 to 6 h, alteplase increased the mean extent of MVO compared with placebo: 1.14% (placebo) versus 3.11% (10 mg) versus 5.20% (20 mg); p = 0.009 for the trend. The interaction between ischemic time and alteplase dose was statistically significant (p = 0.018). CONCLUSION: In patients presenting with ST-segment elevation myocardial infarction and an ischemic time >/=4 to 6 h, adjunctive treatment with low-dose intracoronary alteplase during primary percutaneous coronary intervention was associated with increased MVO. Intracoronary alteplase may be harmful for this subgroup. (A Trial of Low-Dose Adjunctive Alteplase During Primary PCI [T-TIME]; NCT02257294).
DOI: 10.1016/j.jacc.2020.01.041
ISSN: 0735-1097
Publicaton type: Journal Article
Keywords: Cardiology
Heart Disease
Study or Trial: Multicentre Studies
Appears in Collections:Cardiology

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