title: Randomized angiographic trial of recombinant tissue-type plasminogen activator (alteplase) in myocardial infarction. RAAMI Study Investigators.
abstract: Clot dissolution with restoration of infarct-related artery blood flow is the likely mechanism for the improved prognosis and mortality reduction seen after thrombolytic therapy of acute myocardial infarction. A pilot study has suggested that 100 mg of recombinant tissue-type plasminogen activator (rt-PA) infused over 90 min may lead to higher patency rates than the current standard of 100 mg over 3 h. In this multicenter, randomized, open label trial, 281 patients with acute myocardial infarction receive 100 mg of rt-PA according to either the standard 3-h infusion regimen (an initial 10-mg bolus followed by 50 mg for the 1st h, then 20 mg/h for 2 h) or an accelerated 90-min regimen (15-mg bolus followed by 50 mg over 30 min, then 35 mg over 60 min). All patients also received intravenous heparin and oral aspirin during and after rt-PA infusion. At 60 min after initiation of the rt-PA infusion, the observed angiographic patency rates were 76% (95% confidence intervals 65% to 84%) in the accelerated regimen group and 63% in the control group (52% to 73%, p = 0.03). At 90 min these rates were 81% (73% to 87%) and 77% (68% to 84%), respectively (p = 0.21). Both randomized groups experienced similar rates of recurrent ischemia, reinfarction, angiographic reocclusion, other complications of myocardial infarction (including stroke and death) and bleeding complications.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Cardiology, Mother Frances Heart Institute, Tyler, Texas 75701.
authors.forename: R J
authors.initials: RJ
authors.lastname: Carney
authors.forename: G A
authors.initials: GA
authors.lastname: Murphy
authors.forename: T R
authors.initials: TR
authors.lastname: Brandt
authors.forename: P J
authors.initials: PJ
authors.lastname: Daley
authors.forename: E
authors.initials: E
authors.lastname: Pickering
authors.forename: H J
authors.initials: HJ
authors.lastname: White
authors.forename: T J
authors.initials: TJ
authors.lastname: McDonough
authors.forename: S K
authors.initials: SK
authors.lastname: Vermilya
authors.forename: S L
authors.initials: SL
authors.lastname: Teichman
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D017023:Coronary Angiography; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014654:Vascular Patency
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator