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Combined fibrinolysis using reduced-dose alteplase plus abciximab with immediate rescue angioplasty versus primary angioplasty with adjunct use of abciximab for the treatment of acute myocardial infarction: Asia-Pacific Acute Myocardial Infarction Trial (APAMIT) pilot study.
MedLine Citation:
PMID:  15274152     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We conducted a randomized feasibility pilot study comparing combined fibrinolysis with immediate rescue angioplasty vs. primary angioplasty with adjunctive abciximab in patients with acute myocardial infarction (AMI). Seventy patients with ST segment elevation AMI of </= 6 hr were randomized to either 50 mg of alteplase and abciximab (n = 34) or primary angioplasty with adjunctive abciximab (n = 36). Coronary angiography was performed at 60 min in the combined lytic group and TIMI 3 flow was present in 65% of patients as compared to 25% (P = 0.001) in the primary angioplasty group prior to intervention. Treatment success, defined as TIMI 3 flow, was achieved in 83% of patients in the primary angioplasty group (P = 0.075 compared to 65% in combined lytic group before rescue angioplasty). There was no difference in overall treatment success between primary angioplasty and combined lytic group with rescue angioplasty (83% vs. 94%; P = NS). Major adverse cardiac events at 1 month were not significant (15% vs. 11%; P = NS), but there was a trend toward more events in the combined lytic group at 6 months (32% vs. 14%; P = 0.066), particularly in target vessel revascularization. In this feasibility pilot study, high rate of TIMI 3 flow was attained in patients with AMI with both combined fibrinolysis and primary angioplasty with adjunctive abciximab. A larger randomized trial is currently ongoing to compare these two strategies.
Authors:
Aaron Wong; Koon-Hou Mak; Charles Chan; Tian-Hai Koh; Kean-Wah Lau; Tai-Tian Lim; Soo-Teik Lim; Philip Wong; Ling-Ling Sim; Yean-Teng Lim; Huay-Cheem Tan; Yean-Leng Lim
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  62     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-07-26     Completed Date:  2008-02-07     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  445-52     Citation Subset:  IM    
Copyright Information:
Copyright 2004 Wiley-Liss, Inc.
Affiliation:
Department of Cardiology, National Heart Centre, Singapore. aaron_wong@nhc.com.sg
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary* / adverse effects,  instrumentation
Antibodies, Monoclonal / adverse effects,  therapeutic use*
Cardiovascular Diseases / etiology
Combined Modality Therapy
Coronary Angiography
Coronary Circulation
Drug Therapy, Combination
Feasibility Studies
Female
Fibrinolytic Agents / administration & dosage,  adverse effects,  therapeutic use*
Hemorrhage / chemically induced
Humans
Immunoglobulin Fab Fragments / adverse effects,  therapeutic use*
Male
Middle Aged
Myocardial Infarction / drug therapy,  physiopathology,  radiography,  therapy*
Pilot Projects
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Research Design
Singapore
Stents*
Time Factors
Tissue Plasminogen Activator / administration & dosage,  adverse effects,  therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Fibrinolytic Agents; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; EC 3.4.21.68/Tissue Plasminogen Activator; X85G7936GV/abciximab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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