Mechanism of benefit of combination thrombolytic therapy for acute myocardial infarction: A quantitative angiographic and hematologic study
| Autor: | Stephen G. Ellis, Kristina N. Sigmon, Dean J. Kereiakes, Thomas C. Wall, Eric J. Topol, Robert M. Califf, Lynn H. Woodlief, Jeffrey L. Anderson, Jeffrey J. Popma, Joseph Samaha, Barry S. George, David C. Stump, Seth J. Worley |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
medicine.medical_specialty
Cardiac Catheterization Time Factors Combination therapy medicine.medical_treatment Myocardial Infarction Lumen (anatomy) Fibrinogen Coronary Angiography Fibrin Ventricular Function Left Internal medicine medicine Humans Thrombolytic Therapy Myocardial infarction Urokinase Hemostasis Chi-Square Distribution biology business.industry Liter Thrombolysis Blood Proteins medicine.disease Urokinase-Type Plasminogen Activator Recombinant Proteins Surgery Tissue Plasminogen Activator Cardiology biology.protein Cineangiography Regression Analysis Drug Therapy Combination business Cardiology and Cardiovascular Medicine medicine.drug |
| Zdroj: | Journal of the American College of Cardiology. 20(6):1305-1312 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/0735-1097(92)90241-e |
| Popis: | Objectives. The goal of this study was to lend insight into the mechanisms responsible for the beneficial effects of combination thrombolytic therapy. Background. Combination thrombolytic therapy for acute myocardial infarction bas been associated with less reocclusion and fewer in-hospital clinical events than has monotherapy. Methods. Infarct-related quantitative coronary dimensions and hemostatic protein levels were evaluated in 287 patients with acute myocardial infarction during the early (90-min) and convalescent (7-day) phases after administration of recombinant tissue-type plasminogen activator (rt-PA), urokinase or combination rt-PA and urokinase. Results. Minimal lumen diameter was similar in the 90-min and 7-day phases after treatment with rt-PA, urokinase and combination rt-PA and urokinase (0.72 ± 0.45 mm, 0.62 ± 0.53 mm and 0.75 ± 0.58 mm, respectively, at 90 min, p = 0.16; and 1.05 ± 0.56 mm, 1.12 ± 0.72 mm and 0.94 ± 0.54 mm, respectively, at 7 days, p = 0.22). In-hospital clinical event and reocclusion rates were less frequent in patients receiving combination therapy than in those receiving monotherapy (25% vs. 38% and 32% for rt-PA and urokinase, respectively, p = 0.084; and 3% vs. 13% and 9% for rt-PA and urokinase, respectively, p = 0.03), but these events were unrelated to early or late coronary dimensions. Patients receiving combination therapy or urokinase monotherapy had significantly higher peak fibrin degradation products (1,307 ± 860 and 1,285 ± 898 μg/ml vs. 435 ± 717 μg/ml, respectively, p < 0.0001) and lower nadir fibrinogen levels (0.85 ± 1.00 and 0.75 ± 0.53 g/liter vs. 1.90 ± 0.86 g/liter, respectively, p < 0.0001) than did those receiving rt-PA monotherapy. Peak fibrinogen degradation products indirectly correlated (p = 0.004) and baseline (p = 0.026) and nadir (p = 0.089) fibrinogen levels directly correlated with reocclusion. Conclusions. Lower in-hospital clinical event and reocclusion rates observed with combination thrombolytic therapy may relate to systemic hematologic factors rather than to the residual lumen obstruction after thrombolysis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|