February 1, 1987Circulation
A randomized, placebo-controlled trial of intravenous recombinant tissue-type plasminogen activator and emergency coronary angioplasty in patients with acute myocardial infarction.
Why the study?
Does t-PA followed by immediate PTCA improve vessel patency and reduce recurrent ischemia in patients with evolving transmural myocardial infarction?
Population
50 patients with evolving transmural myocardial infarction, treated 3.8 +/- 1.1 hr after onset of symptoms.
Comparison
Tissue-type plasminogen activator 1.25 mg/kg iv… vs Placebo and no PTCA.
Design
RCT, 3:1 randomization for t-PA vs placebo; second randomization to immediate…
Follow-up
1 week
Authors
Discussion
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Member takes
Implication
Supports early t-PA in acute transmural MI; confirms thrombolytic benefit and extends evaluation of immediate PTCA.
Structured PICO
Does t-PA followed by immediate PTCA improve vessel patency and reduce recurrent ischemia in patients with evolving transmural myocardial infarction?
P
Population
50 patients with evolving transmural myocardial infarction, treated 3.8 +/- 1.1 hr after onset of symptoms.
I
Intervention
Tissue-type plasminogen activator (t-PA) 1.25 mg/kg iv over 3 hrs, followed by a second randomization to immediate percutaneous transluminal coronary angioplasty (PTCA) for those with recanalization and residual stenosis ≥50%.
C
Comparator
Placebo (for the initial t-PA randomization) and no PTCA (for the second randomization among those with recanalization).
O
Outcome
Patency of the infarct-related vessel at emergency coronary arteriography.surrogate
In patients with acute myocardial infarction, t-PA significantly improves early infarct-related vessel patency, and immediate PTCA further reduces the incidence of postinfarction angina and reinfarction compared to t-PA alone.
Cite This Study
Topol et al. (1987) studied this question.