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dc.contributor.authorFord, Tom-
dc.contributor.otherMcCartney, P.J.-
dc.contributor.otherMaznyczka, A.M.-
dc.contributor.otherEteiba, H.-
dc.contributor.otherMcEntegart, M.-
dc.contributor.otherOldroyd, K.G.-
dc.contributor.otherGreenwood, J.P.-
dc.contributor.otherMaredia, N.-
dc.contributor.otherSchmitt, M.-
dc.contributor.otherMcCann, G.P.-
dc.contributor.otherFairbairn, T.-
dc.contributor.otherMcAlindon, E.-
dc.contributor.otherTait, C.-
dc.contributor.otherWelsh, P.-
dc.contributor.otherSattar, N.-
dc.contributor.otherOrchard, V.-
dc.contributor.otherCorcoran, D.-
dc.contributor.otherRadjenovic, A.-
dc.contributor.otherMcConnachie, A.-
dc.contributor.otherBerry, C.-
dc.description.abstractBACKGROUND: 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).en
dc.subjectHeart Diseaseen
dc.titleLow-Dose Alteplase During Primary Percutaneous Coronary Intervention According to Ischemic Timeen
dc.typeJournal Articleen
dc.description.affiliatesCentral Coast Local Health Districten
dc.description.affiliatesGosford Hospitalen
dc.identifier.journaltitleJournal of the American College of Cardiologyen
dc.type.studyortrialMulticentre Studiesen
item.openairetypeJournal Article-
item.fulltextNo Fulltext-
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