Please use this identifier to cite or link to this item: https://hdl.handle.net/1/1770
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).
URI: https://elibrary.cclhd.health.nsw.gov.au/cclhdjspui/handle/1/1770
DOI: 10.1016/j.jacc.2020.01.041
Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/32216909
ISSN: 0735-1097
Publicaton type: Journal Article
Keywords: Cardiology
Heart Disease
Study or Trial: Multicentre Studies
Appears in Collections:Cardiology

Show full item record

Page view(s)

22
checked on Jan 31, 2023

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.