| A randomized trial comparing primary angioplasty with a strategy of short-acting thrombolysis and immediate planned rescue angioplasty in acute myocardial infarction: the PACT trial. PACT investigators. Plasminogen-activator Angioplasty Compatibility Trial. | |
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MedLine Citation:
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PMID: 10588209 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The study evaluated the efficacy and safety of a short-acting reduced-dose fibrinolytic regimen to promote early infarct-related artery (IRA) patency during the inherent delay experienced by infarct patients referred for angioplasty as the principal recanalization modality. BACKGROUND: Previous approaches using long-acting, full-dose thrombolytic infusions rarely showed benefit, but they did increase adverse event rates. METHODS: Following aspirin and heparin, 606 patients were randomized to a 50-mg bolus of recombinant tissue-type plasminogen activator (rt-PA) (alpha half-life 4.5 min) or to placebo followed by immediate angiography with angioplasty if needed. The end points included patency rates on catheterization laboratory (cath lab) arrival, technical results when PTCA (percutaneous transluminal coronary angioplasty) was performed, complication rates, and left ventricular (LV) function by treatment assignment and time to restored patency following angioplasty. RESULTS: Patency on cath lab arrival was 61% with rt-PA (28% Thrombolysis in Myocardial Infarction trial [TIMI]-2, 33% TIMI-3), and 34% with placebo (19% TIMI-2, 15% TIMI-3) (p = 0.001). Rescue and primary PTCA restored TIMI-3 in closed arteries equally (77%, 79%). No differences were observed in stroke or major bleeding. Left ventricular function was similar in both treatment groups, but convalescent ejection fraction (EF) was highest with a patent IRA (TIMI-3) on cath lab arrival (62.4%) or when produced by angioplasty within an hour of bolus (62.5%). However, in 88% of angioplasties, the delay exceeded 1 h: convalescent EF 57.3%. CONCLUSIONS: Tailored thrombolytic regimens compatible with subsequent interventions lead to more frequent early recanalization (before cath arrival), which facilitates greater LV function preservation with no augmentation of adverse events. |
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Authors:
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A M Ross; K S Coyne; J S Reiner; S W Greenhouse; C Fink; A Frey; E Moreyra; M Traboulsi; N Racine; A L Riba; M A Thompson; S Rohrbeck; C F Lundergan |
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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: 34 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1999 Dec |
Date Detail:
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Created Date: 1999-12-17 Completed Date: 1999-12-17 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: 1954-62 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Research Institute of George Washington University, Washington, DC 20037, USA. allanmross@aol.com |
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* Aspirin / therapeutic use Combined Modality Therapy Coronary Angiography Double-Blind Method Drug Therapy, Combination Electrocardiography Female Fibrinolytic Agents / therapeutic use* Heparin / therapeutic use Humans Infusions, Intravenous Male Middle Aged Myocardial Contraction / drug effects Myocardial Infarction / physiopathology, radiography, therapy* Recombinant Proteins Recurrence / prevention & control Safety Stroke Volume / drug effects Thrombolytic Therapy / methods* Tissue Plasminogen Activator / therapeutic use* Treatment Outcome Ventricular Function, Left / drug effects |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; 0/Recombinant Proteins; 50-78-2/Aspirin; 9005-49-6/Heparin; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 1999 Dec;34(7):1963-5
[PMID:
10588210
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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