[Advantages of immediate coronary dilatation after thrombolysis using tissue-type plasminogen activator in acute myocardial infarction. A European Cooperative Group trial].
A randomized trial was carried out in 367 patients with acute myocardial infarction to find out whether an "invasive" treatment consisting of intravenous thrombolysis with the tissue plasminogen activator (rt-PA) immediately followed by transluminal coronary angioplasty (group 1, n = 183) was superior to thrombolysis alone (group 2, n = 184). All patients received: 1. rt-PA (100 mg over 3 hours) started 156 minutes (range 30-294 mn) after the onset of symptoms; 2. heparin (5.000 IU as bolus injection, then 1.000 IU/hour), and 3. aspirin (250 mg i.v.). Coronary arteriography was performed 42 minutes (range 6-165 mn) later in 180 of the 183 patients in group 1. Following angioplasty, carried out in 168 patients, the immediate coronary patency rate was 89 p. 100 with a less than 50 p. 100 residual stenosis in 61 p. 100 of the patients. Immediate re-occlusion occurred in 23 p. 100 of the cases. Group 2 patients had a more favourable clinical course: mortality rate on the 14th day 3 p. 100 vs 7 p. 100, recurrent ischaemia within the first 24 hours 3 p. 100 vs 17 p. 100, and from 24 hours to the 14th day 11 p. 100 vs 13 p. 100, ventricular fibrillation 3 p. 100 vs 11 p. 100, haemorrhagic complications 23 p. 100 vs 41 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)
Vahanian
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Service de cardiologie, hôpital Tenon, Paris.
D000800:Angioplasty, Balloon; D001241:Aspirin / Q000627:therapeutic use; D017023:Coronary Angiography; D003327:Coronary Disease / Q000209:etiology; D003331:Coronary Vessels; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D011897:Random Allocation; D012008:Recurrence; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D006493:Heparin; D010959:Tissue Plasminogen Activator; D001241:Aspirin
Bénéfice de la dilatation coronaire immédiate après thrombolyse par l'activateur tissulaire du plasminogène dans l'infarctus myocardique aigu. Essai du groupe coopératif européen.