Does a higher initial bolus dose (30% vs 10%) of intravenous rt-PA improve coronary recanalization rate and reduce infarct size in Japanese acute myocardial infarction patients?
A 30% initial bolus of rt-PA achieves faster coronary recanalization and smaller infarct size compared to a 10% bolus in patients with acute myocardial infarction.
Coronary recanalization rate and infarct size were compared between 2 different methods of intravenously administering recombinant tissue-type plasminogen activator (rt-PA) 41.4 mg; 1) an initial bolus dose of 30% followed by infusion of the remainder over 60 min (30% group), and an initial bolus dose of 10% followed by infusion of the remainder over 60 min (10% group). Thirty min after beginning rt-PA infusion, the coronary recanalization rate was higher in the 30% group than in the 10% group (82.9% (34/41) vs 53.7% (22/41), p < 0.01). The peak creatine kinase and peak creatine kinase-MB levels were lower in the 30% group than in the 10% group. We conclude that a higher initial bolus dose of rt-PA gives a higher rate of recanalization of the infarct-related artery at the very early phase, and probably leads to a smaller infarct size.
Ogawa et al. (Sun,) studied this question.
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