title: Randomised trial of intravenous recombinant tissue-type plasminogen activator versus intravenous streptokinase in acute myocardial infarction. Report from the European Cooperative Study Group for Recombinant Tissue-type Plasminogen Activator.
abstract: In a single-blind randomised trial in patients with acute myocardial infarction of less than 6 h duration, the frequency of coronary patency was found to be higher after intravenous administration of recombinant human tissue-type plasminogen activator (rt-PA) than after intravenous streptokinase. 64 patients were allocated to 0.75 mg rt-PA/kg over 90 min, and the infarct-related coronary artery was patent in 70% of 61 assessable coronary angiograms taken 75-90 min after the start of infusion; 65 patients were allocated to 1 500 000 IU streptokinase over 60 min, and the infarct-related vessel was patent in 55% of 62 assessable angiograms. The 95% confidence interval of the differences ranges from +/- 30 to -2% (p = 0.054). Bleeding episodes and other complications were less common in the rt-PA patients than in the streptokinase group. Hospital mortality was identical in the 2 treatment groups. At the end of the rt-PA infusion the circulating fibrinogen level was 61 +/- 35% of the starting value, as measured by a coagulation-rate assay, and 69 +/- 25% as measured by sodium sulphite precipitation. After streptokinase infusion, corresponding fibrinogen levels were 12 +/- 18% and 20 +/- 11%. In the rt-PA group only 4.5% of the fibrinogen was measured as incoagulable fibrinogen degradation products, compared with 30% in the streptokinase group. Activation of the systemic fibrinolytic system was far less pronounced with rt-PA than with streptokinase.
authors.forename: M
authors.initials: M
authors.lastname: Verstraete
authors.forename: R
authors.initials: R
authors.lastname: Bernard
authors.forename: M
authors.initials: M
authors.lastname: Bory
authors.forename: R W
authors.initials: RW
authors.lastname: Brower
authors.forename: D
authors.initials: D
authors.lastname: Collen
authors.forename: D P
authors.initials: DP
authors.lastname: de Bono
authors.forename: R
authors.initials: R
authors.lastname: Erbel
authors.forename: W
authors.initials: W
authors.lastname: Huhmann
authors.forename: R J
authors.initials: RJ
authors.lastname: Lennane
authors.forename: J
authors.initials: J
authors.lastname: Lubsen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011859:Radiography; D013300:Streptokinase / Q000627:therapeutic use*
chemical_list: D005340:Fibrinogen; D013300:Streptokinase; D010960:Plasminogen Activators