Please use this identifier to cite or link to this item:
|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
|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
|Study or Trial:||Multicentre Studies|
|Appears in Collections:||Cardiology|
Show full item record
checked on Jan 31, 2023
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.