Document Detail

Thrombolysis with tissue plasminogen activator in suspected acute myocardial infarction. The ASSET Study.
MedLine Citation:
PMID:  2495910     Owner:  NLM     Status:  MEDLINE    
Intravenous rtPA (total dose, 100 mg over 3 h) was compared with placebo in a prospective, randomized, double-blind trial in 5,011 patients with suspected AMI of less than 5 h duration. No ECG or enzymatic confirmation of the diagnosis was required for study entry. At 1 month 9.8% of patients given placebo had died compared with 7.2% of those who received rtPA (2.6% actual reduction, 26% relative reduction, with 95% confidence intervals of 11-39%). The majority of deaths occurred in patients who had an in-hospital diagnosis of MI (72% in both groups), with a 1-month infarct mortality of 13.1% in the placebo limb and 9.4% in the rtPA limb (relative reduction 28%, 95% CI, 14-41%). Approximately 18% of patients in both groups had a normal ECG on entry to the trial, and at 1 month the fatality was 1.6% in the rtPA group and 3.0% in the placebo group. Treatment with rtPA did not reduce the number of patients with normal ECGs from developing MI (28% rtPA vs 24% placebo). Treatment with rtPA was associated with significantly more bleeding episodes, the vast majority of which were clinically minor. The risk of all strokes in the rtPA group was similar to that in the placebo group (1.1% vs 1.0%). Treatment with rtPA was unaccompanied by either allergic or hypotensive episodes, and, among rtPA treated patients, there was no increase in clinically important ventricular dysrhythmias. Neither age nor time from onset of symptoms reduced the benefit from rtPA.
R G Wilcox
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Chest     Volume:  95     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1989 May 
Date Detail:
Created Date:  1989-06-02     Completed Date:  1989-06-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  270S-275S     Citation Subset:  AIM; IM    
Department of Medicine, University Hospital, Nottingham, England.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Double-Blind Method
Great Britain
Middle Aged
Multicenter Studies as Topic
Myocardial Infarction / drug therapy*,  mortality
Prospective Studies
Random Allocation
Recombinant Proteins / therapeutic use
Tissue Plasminogen Activator / therapeutic use*
Reg. No./Substance:
0/Placebos; 0/Recombinant Proteins; EC Plasminogen Activator

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

Previous Document:  Comparison of tissue plasminogen activator and streptokinase in the management of acute myocardial i...
Next Document:  How to select patients with deep vein thrombosis for tPA therapy.