Are the Various Thrombolytic Agents Equally Effective in the Treatment of Acute Transmural Myocardial Infarction?

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Acute transmural myocardial infarction (n=160). Intervention: Anistreplase vs. Streptokinase or Alteplase. Primary outcome: Patency of coronary arteries (absence of total occlusion) at 3 to 4 weeks (p=<0.01).

J Claessens; Christiane HASELDONCKX

doi:10.1536/ihj.33.413

January 1, 1992Japanese Heart JournalOpen Access

Are the Various Thrombolytic Agents Equally Effective in the Treatment of Acute Transmural Myocardial Infarction?

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Key result

Anistreplase resulted in a higher rate of patent coronary arteries at 3 to 4 weeks compared to streptokinase and alteplase in patients with acute transmural myocardial infarction.

Why the study?

Does anistreplase improve coronary artery patency compared to streptokinase or alteplase in patients with acute transmural myocardial infarction?

Study Design

Type

RCT (n=160)

Randomization

Randomized

Multicenter

Yes

Structured PICO

Does anistreplase improve coronary artery patency compared to streptokinase or alteplase in patients with acute transmural myocardial infarction?

P

Population

160 patients with acute transmural myocardial infarction presenting within 4 hours of symptom onset, randomized to anistreplase, streptokinase, or alteplase, and evaluated for coronary patency at 3 to 4 weeks.

I

Intervention

Anistreplase 30 U IV over 5 minutes, followed 6 hours later by heparin infusion (25,000 U per 24 hours for 6 days) and oral acetylsalicylic acid 150 mg/day.

C

Comparator

Streptokinase 1,500,000 U IV over 1 hour OR alteplase 100 mg IV over 1 hour, both followed 6 hours later by the same heparin and acetylsalicylic acid regimen.

O

Outcome

Patency of coronary arteries (absence of total occlusion) determined by coronary angiography at 3 to 4 weeks (1 month) after the acute myocardial infarction.surrogate

Main Result

Absolute Event Rate: 73% vs 47.5%

p-value: p=<0.01

Anistreplase may provide superior coronary patency at 1 month compared to streptokinase and alteplase in acute myocardial infarction, with reperfusion arrhythmias serving as a marker of successful recanalization.

Limitations

Small sample size of 160 patients.
Heparin infusion was not started until 6 hours after the administration of the thrombolytic agent, which may have negatively impacted alteplase efficacy.
Coronary angiography was not performed in all patients (42 patients were excluded from the angiographic analysis).
Restricted number of patients (small sample size)
Heparin infusion was delayed until 6 hours after thrombolytic administration, which may have negatively affected alteplase efficacy

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Implication

Supports anistreplase preference for thrombolysis in acute transmural MI; extends RCT data on sustained coronary patency.

Abstract

While it is no longer possible to imagine the treatment of an acute transmural myocardial infarction without the use of thrombolytic agents, some discussion still exists as to the choice of the thrombolytic agent. Our study concerns a group of 160 patients with an acute transmural myocardial infarction, 60 of whom were treated with anistreplase, 52 with streptokinase and 48 with alteplase. Statistically, the administration of anistreplase was associated with a significantly higher frequency of ventricular arrhythmias in comparison to the other thrombolytic agents, whereas after subsequent coronary angiography, the anistreplase group revealed a significantly lower number of completely occluded coronary arteries. The data from this study demonstrate that anistreplase is a very valuable thrombolytic agent. It may even be more effective than streptokinase and alteplase in the treatment of acute myocardial infarction when the patency of the coronary arteries 1 month after the acute coronary event is considered the primary endpoint.

Discussion

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Cite This Study

Claessens et al. (1992) conducted an RCT in Acute transmural myocardial infarction (n=160). Anistreplase vs. Streptokinase or Alteplase was evaluated on Patency of coronary arteries (absence of total occlusion) at 3 to 4 weeks (p=<0.01). Anistreplase resulted in a higher rate of patent coronary arteries at 3 to 4 weeks compared to streptokinase and alteplase in patients with acute transmural myocardial infarction.

synapsesocial.com/papers/6a9bcf5413c692f0fc8fec96 https://doi.org/10.1536/ihj.33.413

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Are the Various Thrombolytic Agents Equally Effective in the Treatment of Acute Transmural Myocardial Infarction?

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Are the Various Thrombolytic Agents Equally Effective in the Treatment of Acute Transmural Myocardial Infarction?

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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