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July 1, 1992CirculationOpen Access

Recombinant tissue-type plasminogen activator and immediate angioplasty in acute myocardial infarction. One-year follow-up. The European Cooperative Study Group.

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Why the study?

Does alteplase or immediate PTCA in addition to alteplase improve 1-year mortality in patients with acute myocardial infarction?

Population

1,088 patients with suspected myocardial infarction, chest pain of less than 5 hours, and extensive…

Comparison

Alteplase 100 mg over 3 hours or immediate… vs Placebo or control without immediate PTCA. All…

Design

RCT, allocated at random, double-blind (for alteplase/placebo trial)

Follow-up

1 year

Authors

AAAlfred ArnoldMSM. L. SimoonsFWFrans Van de Werf

Discussion

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Overview

Alteplase sustains 1-year mortality benefit in AMI while immediate PTCA does not; confirms long-term thrombolytic efficacy and challenges routine adjunctive angioplasty.

Structured PICO

Does alteplase or immediate PTCA in addition to alteplase improve 1-year mortality in patients with acute myocardial infarction?

P
Population
1,088 patients with suspected myocardial infarction, chest pain of less than 5 hours, and extensive ST-segment elevation (721 in alteplase/placebo trial, 367 in alteplase/PTCA trial).
I
Intervention
Alteplase 100 mg over 3 hours (Trial 1) or immediate percutaneous transluminal coronary angioplasty (PTCA) after alteplase (Trial 2). All patients received aspirin and intravenous heparin.
C
Comparator
Placebo (Trial 1) or control without immediate PTCA (Trial 2). All patients received aspirin and intravenous heparin.
O
Outcome
Mortality at 1 yearhard clinical

At 1 year, alteplase maintains its mortality benefit in acute myocardial infarction, while routine immediate PTCA after alteplase does not confer additional benefit and may increase mortality.

Cite This Study

Arnold et al. (1992) studied this question.

synapsesocial.com/papers/6a738d03644e61a44f4e6612https://doi.org/10.1161/01.cir.86.1.111
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Which patients benefit most from early thrombolytic therapy with intracoronary streptokinase?1986 · 134 citations
  2. 2Comparison of Invasive and Conservative Strategies after Treatment with Intravenous Tissue Plasminogen Activator in Acute Myocardial Infarction1989 · 1,024 citations
  3. 3Cost benefit analysis of early thrombolytic treatment with intracoronary streptokinase. Twelve month follow up report of the randomised multicentre trial conducted by the Interuniversity Cardiology Institute of The Netherlands.1988 · 61 citations
  4. 4Nonparametric Estimation from Incomplete Observations1958 · 39,448 citations