title: Low-dose tissue plasminogen activator followed by planned rescue angioplasty reduces time to reperfusion for acute myocardial infarction treated at community hospitals.
abstract: The time from admission to reperfusion in patients with acute myocardial infarction (AMI) was compared according to the type of hospital and treatment strategy. A total of 164 patients with a first AMI within 12h of onset were enrolled at one tertiary emergency center (TEC) and 6 community hospitals (CHs). The subjects were randomly assigned to receive either primary percutaneous transluminal coronary angioplasty (PTCA) (TEC-primary PTCA and CHs-primary PTCA groups) or 800,000 units of intravenous monteplase, half the standard dose of a mutant tissue plasminogen activator (t-PA), followed by rescue PTCA if the Thrombolysis in Myocardial Infarction (TIMI) flow grade was 2 or less (TEC-monteplase and CHs-monteplase groups) on the first coronary angiogram. Sixty minutes after admission, TIMI flow grade 3 rates of the study groups were as follows, in descending order: TEC-monteplase group, CHs-monteplase group, TEC-primary PTCA group, and CHs-primary PTCA group (56%, 41%, 36%, and 8%, respectively; p<0.01). However, there was no significant difference in the final TIMI flow grade 3 rate among the 4 groups. In the CHs, the peak creatine kinase tended to be lower in the monteplase group than in the primary PTCA group. The results suggest that low-dose monteplase followed by rescue PTCA is an effective strategy for promoting early reperfusion in patients with AMI, especially those who are treated at CHs.
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Japan. c-kimura@urahp.yokohama-cu.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Kimura
authors.forename: K
authors.initials: K
authors.lastname: Tsukahara
authors.forename: T
authors.initials: T
authors.lastname: Usui
authors.forename: J
authors.initials: J
authors.lastname: Okuda
authors.forename: Y
authors.initials: Y
authors.lastname: Kitamura
authors.forename: M
authors.initials: M
authors.lastname: Kosuge
authors.forename: T
authors.initials: T
authors.lastname: Sano
authors.forename: S
authors.initials: S
authors.lastname: Tohyama
authors.forename: O
authors.initials: O
authors.lastname: Yamanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Yoshii
authors.forename: S
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000592:standards; D002985:Clinical Protocols; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006764:Hospitals, Community / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D003402:Creatine Kinase; D010959:Tissue Plasminogen Activator