title: Combined angioplasty and pharmacological intervention versus thrombolysis alone in acute myocardial infarction (CAPITAL AMI study).
abstract: OBJECTIVE
  We compared a strategy of tenecteplase (TNK)-facilitated angioplasty with one of TNK alone in patients presenting with high-risk ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Previous trials show that thrombolysis followed by immediate angioplasty for the treatment of STEMI does not improve ischemic outcomes compared with thrombolysis alone and is associated with excessive bleeding complications. Since the publication of these trials, however, significant pharmacological and technological advances have occurred.
  
  
  METHODS
  We randomized 170 patients with high-risk STEMI to treatment with TNK alone (84 patients) or TNK-facilitated angioplasty (86 patients). The primary end point was a composite of death, reinfarction, recurrent unstable ischemia, or stroke at six months.
  
  
  RESULTS
  At six months, the incidence of the primary end point was 24.4% in the TNK-alone group versus 11.6% in the TNK-facilitated angioplasty group (p = 0.04). This difference was driven by a reduction in the rate of recurrent unstable ischemia (20.7% vs. 8.1%, p = 0.03). There was a trend toward a lower reinfarction rate with TNK-facilitated angioplasty (14.6% vs. 5.8%, p = 0.07). No significant differences were observed in the rates of death or stroke. Major bleeding was observed in 7.1% of the TNK-alone group and in 8.1% of the TNK-facilitated angioplasty group (p = 1.00).
  
  
  CONCLUSIONS
  In patients presenting with high-risk STEMI, TNK plus immediate angioplasty reduced the risk of recurrent ischemic events compared with TNK alone and was not associated with an increase in major bleeding complications.
authors.affiliation: Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada. mlemay@ottawaheart.ca
authors.forename: Michel R
authors.initials: MR
authors.lastname: Le May
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.forename: Marino
authors.initials: M
authors.lastname: Labinaz
authors.forename: Richard F
authors.initials: RF
authors.lastname: Davies
authors.forename: Michele
authors.initials: M
authors.lastname: Turek
authors.forename: Danielle
authors.initials: D
authors.lastname: Leddy
authors.forename: Justin
authors.initials: J
authors.lastname: Maloney
authors.forename: Tim
authors.initials: T
authors.lastname: McKibbin
authors.forename: Brendan
authors.initials: B
authors.lastname: Quinn
authors.forename: Rob S
authors.initials: RS
authors.lastname: Beanlands
authors.forename: Chris
authors.initials: C
authors.lastname: Glover
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Marquis
authors.forename: Edward R
authors.initials: ER
authors.lastname: O'Brien
authors.forename: William L
authors.initials: WL
authors.lastname: Williams
authors.forename: Lyall A
authors.initials: LA
authors.lastname: Higginson
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001241:Aspirin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D000077785:Tenecteplase; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator; D001241:Aspirin; D000077785:Tenecteplase