Document Detail


Effectiveness and safety of a single intravenous bolus injection of tissue-type plasminogen activator in acute myocardial infarction. Bolus Dose-Escalation Study of Tissue-Type Plasminogen Activator (BEST) Investigators.
MedLine Citation:
PMID:  1590225     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The efficacy of multiple intravenous bolus injections of tissue-type plasminogen activator (t-PA) in inducing rapid coronary recanalization in patients with acute myocardial infarction was previously demonstrated. In this Bolus Dose-Escalation Study of Tissue-Type Plasminogen Activator (BEST), the efficacy of 3 different doses of a single rapid intravenous bolus injection of t-PA (dute-plase, Wellcome Foundation, London) in inducing coronary patency (Thrombolysis In Myocardial Infarction perfusion grade 2 or 3) in 64 patients with acute myocardial infarction presenting less than 6 hours after onset of symptoms was investigated. At 60 minutes after administration of t-PA, the infarct-related coronary artery was patent in 9 of 17 patients (53%; 95% confidence interval [CI] 28 to 77%) after 0.3 MU/kg, in 14 of 23 (61%; 95% CI 39 to 80%) after 0.45 MU/kg and in 10 of 14 (71%; 95% CI 42 to 92%) after 0.6 MU/kg. At 90 minutes after t-PA, coronary patency was present in 9 of 17 cases (53%; 95% CI 28 to 77%) after 0.3 MU/kg, in 12 of 24 (50%; 95% CI 29 to 71%) after 0.45 MU/kg and in 10 of 13 (77%; 95% CI 46 to 95%) after 0.6 MU/kg. One patient in each dose group had a silent reoccluded infarct-related artery by 24 hours, and there were 2 clinical reinfarctions before discharge. No major bleeding events were observed. There were 5 hospital deaths, all unrelated to t-PA. A single intravenous bolus injection of 0.6 MU/kg of t-PA appears to be effective in inducing rapid coronary patency and to be safe in patients with acute myocardial infarction.
Authors:
D Hackett; F Andreotti; A W Haider; C Brunelli; M Shahi; A Fussell; N Buller; R Foale; D Lipkin; S Caponnetto
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  69     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1992 Jun 
Date Detail:
Created Date:  1992-06-24     Completed Date:  1992-06-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1393-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Electrocardiography
Female
Fibrinogen / analysis
Humans
Injections, Intravenous
Male
Middle Aged
Myocardial Infarction / blood,  drug therapy*,  physiopathology
Recurrence
Thrombolytic Therapy / adverse effects,  methods*
Tissue Plasminogen Activator / administration & dosage*,  adverse effects
Vascular Patency
Chemical
Reg. No./Substance:
9001-32-5/Fibrinogen; EC 3.4.21.68/Tissue Plasminogen Activator

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