Effects of thrombolytic therapy administered 6 to 24 hours after myocardial infarction on the signal-averaged ECG. Results of a multicenter randomized trial. LATE Ancillary Study Investigators. Late Assessment of Thrombolytic Efficacy
| Autor: | P. Theroux, C D Naylor, E. J. Topol, P Dorian, Judith S. Hochman, P. W. Armstrong, Jonathan S. Steinberg, C. D. Morgan |
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| Rok vydání: | 1994 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Myocardial Infarction law.invention Electrocardiography Double-Blind Method Randomized controlled trial Risk Factors law Physiology (medical) Internal medicine Fibrinolysis medicine Humans Thrombolytic Therapy Prospective Studies Myocardial infarction Prospective cohort study medicine.diagnostic_test business.industry Signal Processing Computer-Assisted Ancillary Study Middle Aged medicine.disease Recombinant Proteins Signal-averaged electrocardiogram Surgery Clinical trial Tissue Plasminogen Activator Tachycardia Ventricular Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 90:746-752 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | BACKGROUND Thrombolytic therapy reduces mortality after acute myocardial infarction, even when treatment is initiated relatively late after onset of symptoms. The mechanism underlying this survival benefit is incompletely understood. METHODS AND RESULTS In a prospectively designed ancillary study of a randomized, placebo-controlled trial of late thrombolytic therapy (LATE), the signal-averaged (SA) ECG was recorded before hospital discharge in an effort to assess the effect of thrombolytic therapy on arrhythmia substrate. Three hundred ten patients were enrolled at 23 participating sites; 160 patients received placebo, and 150 patients received recombinant tissue-type plasminogen activator (rTPA) therapy 6 to 24 hours after onset of symptoms. Compared with placebo, rTPA tended to reduce the frequency of SAECG abnormality (filtered QRS duration > 120 milliseconds) by 37% (95% CI, -64%, +6%; P = .087) and the filtered QRS duration (105.7 +/- 13.8 versus 108.8 +/- 14.6 milliseconds, P = .05). In the prespecified subgroup of 185 patients with ST elevation on the qualifying ECG, rTPA resulted in a 52% reduction (95% CI, 4% to 77%, P = .011) of SAECG abnormality and a shorter filtered QRS duration (105.7 +/- 10.9 versus 110.7 +/- 15.9 milliseconds, P = .01). No benefit was seen in patients without ST elevation on ECG. CONCLUSIONS Late thrombolytic therapy produced a more stable electrical substrate, which probably represents an important mechanism of mortality benefit. |
| Databáze: | OpenAIRE |
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