Low-Dose Tissue Plasminogen Activator Followed by Planned Rescue Angioplasty Reduces Time to Reperfusion for Acute Myocardial Infarction Treated at Community Hospitals

概要

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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 teated at CHs.
社団法人日本循環器学会の論文
2001-09-20