| Combined angioplasty and pharmacological intervention versus thrombolysis alone in acute myocardial infarction (CAPITAL AMI study). | |
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MedLine Citation:
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PMID: 16053952 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We compared a strategy of tenecteplase (TNK)-facilitated angioplasty with one of TNK alone in patients presenting with high-risk ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Previous trials show that thrombolysis followed by immediate angioplasty for the treatment of STEMI does not improve ischemic outcomes compared with thrombolysis alone and is associated with excessive bleeding complications. Since the publication of these trials, however, significant pharmacological and technological advances have occurred. METHODS: We randomized 170 patients with high-risk STEMI to treatment with TNK alone (84 patients) or TNK-facilitated angioplasty (86 patients). The primary end point was a composite of death, reinfarction, recurrent unstable ischemia, or stroke at six months. RESULTS: At six months, the incidence of the primary end point was 24.4% in the TNK-alone group versus 11.6% in the TNK-facilitated angioplasty group (p = 0.04). This difference was driven by a reduction in the rate of recurrent unstable ischemia (20.7% vs. 8.1%, p = 0.03). There was a trend toward a lower reinfarction rate with TNK-facilitated angioplasty (14.6% vs. 5.8%, p = 0.07). No significant differences were observed in the rates of death or stroke. Major bleeding was observed in 7.1% of the TNK-alone group and in 8.1% of the TNK-facilitated angioplasty group (p = 1.00). CONCLUSIONS: In patients presenting with high-risk STEMI, TNK plus immediate angioplasty reduced the risk of recurrent ischemic events compared with TNK alone and was not associated with an increase in major bleeding complications. |
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Authors:
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Michel R Le May; George A Wells; Marino Labinaz; Richard F Davies; Michele Turek; Danielle Leddy; Justin Maloney; Tim McKibbin; Brendan Quinn; Rob S Beanlands; Chris Glover; Jean-François Marquis; Edward R O'Brien; William L Williams; Lyall A Higginson |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 46 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2005 Aug |
Date Detail:
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Created Date: 2005-08-01 Completed Date: 2005-08-30 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 417-24 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada. mlemay@ottawaheart.ca |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary / methods* Aspirin / therapeutic use* Combined Modality Therapy Confidence Intervals Coronary Angiography Coronary Restenosis / epidemiology, radiography* Dose-Response Relationship, Drug Drug Administration Schedule Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction / mortality, radiography, therapy* Probability Risk Assessment Severity of Illness Index Survival Analysis Thrombolytic Therapy / methods* Tissue Plasminogen Activator / therapeutic use* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/tenecteplase; 50-78-2/Aspirin; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
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Evid Based Cardiovasc Med. 2005 Dec;9(4):284-7
[PMID:
16380055
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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