Document Detail


Low-dose tissue plasminogen activator followed by planned rescue angioplasty reduces time to reperfusion for acute myocardial infarction treated at community hospitals.
MedLine Citation:
PMID:  11665796     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The time from admission to reperfusion in patients with acute myocardial infarction (AMI) was compared according to the type of hospital and treatment strategy. A total of 164 patients with a first AMI within 12h of onset were enrolled at one tertiary emergency center (TEC) and 6 community hospitals (CHs). The subjects were randomly assigned to receive either primary percutaneous transluminal coronary angioplasty (PTCA) (TEC-primary PTCA and CHs-primary PTCA groups) or 800,000 units of intravenous monteplase, half the standard dose of a mutant tissue plasminogen activator (t-PA), followed by rescue PTCA if the Thrombolysis in Myocardial Infarction (TIMI) flow grade was 2 or less (TEC-monteplase and CHs-monteplase groups) on the first coronary angiogram. Sixty minutes after admission, TIMI flow grade 3 rates of the study groups were as follows, in descending order: TEC-monteplase group, CHs-monteplase group, TEC-primary PTCA group, and CHs-primary PTCA group (56%, 41%, 36%, and 8%, respectively; p<0.01). However, there was no significant difference in the final TIMI flow grade 3 rate among the 4 groups. In the CHs, the peak creatine kinase tended to be lower in the monteplase group than in the primary PTCA group. The results suggest that low-dose monteplase followed by rescue PTCA is an effective strategy for promoting early reperfusion in patients with AMI, especially those who are treated at CHs.
Authors:
K Kimura; K Tsukahara; T Usui; J Okuda; Y Kitamura; M Kosuge; T Sano; S Tohyama; O Yamanaka; Y Yoshii; S Umemura
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Japanese circulation journal     Volume:  65     ISSN:  0047-1828     ISO Abbreviation:  Jpn. Circ. J.     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-10-22     Completed Date:  2002-11-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7806868     Medline TA:  Jpn Circ J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  901-6     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Yokohama City University Medical Center, Japan. c-kimura@urahp.yokohama-cu.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects,  standards
Clinical Protocols
Creatine Kinase / blood
Female
Hospitals, Community / methods,  standards
Humans
Male
Middle Aged
Myocardial Infarction / complications,  therapy*
Myocardial Reperfusion / adverse effects,  methods*,  standards
Thrombolytic Therapy
Time Factors
Tissue Plasminogen Activator / administration & dosage*
Chemical
Reg. No./Substance:
EC 2.7.3.2/Creatine Kinase; EC 3.4.21.68/Tissue Plasminogen Activator

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