Randomized comparison of coronary thrombolysis achieved with double-bolus reteplase (recombinant plasminogen activator) and front-loaded, accelerated alteplase (recombinant tissue plasminogen activator) in patients with acute myocardial infarction

• Verfasst von: Bode, Christoph [VerfasserIn]
• Verfasst von: Smalling, Richard W. [VerfasserIn]
• Verfasst von: Berg, Gunther [VerfasserIn]
• Verfasst von: Burnett, Curtis [VerfasserIn]
• Verfasst von: Lorch, Gerald [VerfasserIn]
• Verfasst von: Kalbfleisch, John M. [VerfasserIn]
• Verfasst von: Chernoff, Robert [VerfasserIn]
• Verfasst von: Christie, Leonard G. [VerfasserIn]
• Verfasst von: Feldman, Robert L. [VerfasserIn]
• Verfasst von: Seals, A. Allen [VerfasserIn]
• Verfasst von: Weaver, W. Douglas [VerfasserIn]
• Titel: Randomized comparison of coronary thrombolysis achieved with double-bolus reteplase (recombinant plasminogen activator) and front-loaded, accelerated alteplase (recombinant tissue plasminogen activator) in patients with acute myocardial infarction
• Verf.angabe: Christoph Bode, Richard W. Smalling, Gunther Berg, Curtis Burnett, Gerald Lorch, John M. Kalbfleisch, Robert Chernoff, Leonard G. Christie, Robert L. Feldman, A. Allen Seals, W. Douglas Weaver
• E-Jahr: 1996
• Jahr: 1 Sep 1996
• Umfang: 8 S.
• Fussnoten: Gesehen am 24.04.2024
• Titel Quelle: Enthalten in: Circulation
• Ort Quelle: Philadelphia, Pa. : Lippincott, Williams & Wilkins, 1950
• Jahr Quelle: 1996
• Band/Heft Quelle: 94(1996), 5, Seite 891-898
• ISSN Quelle: 1524-4539
• DOI: doi:10.1161/01.CIR.94.5.891
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: myocardial infarction
• Sach-SW: plasminogen activators
• Sach-SW: thrombolysis
• K10plus-PPN: 1886882444

Abstract

Background The therapeutic benefit of thrombolytic therapy has been shown to correlate directly with completeness (TIMI grade 3 flow) and speed of reperfusion of the infarct-related coronary artery. The purpose of the RAPID II study was to determine whether a double-bolus regimen of reteplase, a recently developed deletion mutant of wild-type tissue plasminogen activator, could improve 90-minute coronary artery patency rates achieved with the most successful standard regimen, an “accelerated” front-loaded infusion of alteplase. - - Methods and Results Three hundred twenty-four patients with acute myocardial infarction were randomized to receive (along with intravenous heparin and aspirin) either a 10 plus 10 megaunits double bolus of reteplase or front-loaded alteplase. The primary end point of “patency at 90 minutes, graded according to the TIMI classification” was centrally assessed in a blinded fashion. Infarct-related coronary artery patency (TIMI grade 2 or 3) and complete patency (TIMI grade 3) at 90 minutes after the start of thrombolytic therapy were significantly higher in the reteplase-treated patients (TIMI grade 2 or 3: 83.4% versus 73.3% for front-loaded alteplase-treated patients, P=.03; TIMI grade 3: 59.9% versus 45.2%, P=.01). At 60 minutes, the incidence of both, patency and complete patency, was also significantly higher in reteplase-treated patients (reteplase versus alteplase, TIMI grade 2 or 3: 81.8% versus 66.1%, P=.01; TIMI grade 3: 51.2% versus 37.4%, P<.03). Reteplase-treated patients required fewer acute additional coronary interventions (13.6% versus 26.5%, P<.01), and 35-day mortality was 4.1% for reteplase and 8.4% for alteplase (P=NS). There were no significant differences between reteplase and alteplase in bleedings requiring a transfusion (12.4% versus 9.7%) or hemorrhagic stroke (1.2% versus 1.9%). - - Conclusions Reteplase, when given as a double bolus of 10 plus 10 megaunits to patients with acute myocardial infarction, achieves significantly higher rates of early reperfusion of the infarct-related coronary artery and requires significantly fewer acute coronary interventions than front-loaded alteplase without an apparent increased risk of complications.