title: Effectiveness and safety of a single intravenous bolus injection of tissue-type plasminogen activator in acute myocardial infarction. Bolus Dose-Escalation Study of Tissue-Type Plasminogen Activator (BEST) Investigators.
abstract: The efficacy of multiple intravenous bolus injections of tissue-type plasminogen activator (t-PA) in inducing rapid coronary recanalization in patients with acute myocardial infarction was previously demonstrated. In this Bolus Dose-Escalation Study of Tissue-Type Plasminogen Activator (BEST), the efficacy of 3 different doses of a single rapid intravenous bolus injection of t-PA (dute-plase, Wellcome Foundation, London) in inducing coronary patency (Thrombolysis In Myocardial Infarction perfusion grade 2 or 3) in 64 patients with acute myocardial infarction presenting less than 6 hours after onset of symptoms was investigated. At 60 minutes after administration of t-PA, the infarct-related coronary artery was patent in 9 of 17 patients (53%; 95% confidence interval [CI] 28 to 77%) after 0.3 MU/kg, in 14 of 23 (61%; 95% CI 39 to 80%) after 0.45 MU/kg and in 10 of 14 (71%; 95% CI 42 to 92%) after 0.6 MU/kg. At 90 minutes after t-PA, coronary patency was present in 9 of 17 cases (53%; 95% CI 28 to 77%) after 0.3 MU/kg, in 12 of 24 (50%; 95% CI 29 to 71%) after 0.45 MU/kg and in 10 of 13 (77%; 95% CI 46 to 95%) after 0.6 MU/kg. One patient in each dose group had a silent reoccluded infarct-related artery by 24 hours, and there were 2 clinical reinfarctions before discharge. No major bleeding events were observed. There were 5 hospital deaths, all unrelated to t-PA. A single intravenous bolus injection of 0.6 MU/kg of t-PA appears to be effective in inducing rapid coronary patency and to be safe in patients with acute myocardial infarction.
authors.affiliation: Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Hackett
authors.forename: F
authors.initials: F
authors.lastname: Andreotti
authors.forename: A W
authors.initials: AW
authors.lastname: Haider
authors.forename: C
authors.initials: C
authors.lastname: Brunelli
authors.forename: M
authors.initials: M
authors.lastname: Shahi
authors.forename: A
authors.initials: A
authors.lastname: Fussell
authors.forename: N
authors.initials: N
authors.lastname: Buller
authors.forename: R
authors.initials: R
authors.lastname: Foale
authors.forename: D
authors.initials: D
authors.lastname: Lipkin
authors.forename: S
authors.initials: S
authors.lastname: Caponnetto
mesh_terms: D000328:Adult; D000368:Aged; D004562:Electrocardiography; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012008:Recurrence; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D014654:Vascular Patency
chemical_list: D005340:Fibrinogen; D010959:Tissue Plasminogen Activator