diagnosis of acute mi pharmacologic therapy* immediate angiography ptcaptca other rx *antithrombin...
DESCRIPTION
*All comparisons P< Ross AM, et al. J Am Coll Cardiol. 1999;34: Patency of the Infarct Artery on Catheter Laboratory Arrival (Core Laboratory)TRANSCRIPT
Diagnosis of Diagnosis of acute MIacute MI
Pharmacologic Pharmacologic therapy*therapy*
Immediate Immediate angiographyangiography
PTCAPTCA
Other RxOther Rx
*Antithrombin agents, antiplatelet agents, and fibrinolytic agents.
““Prejunctive” TherapyPrejunctive” Therapy
•A strategy to promote very early patency for some patients (drug responders) and
very high final patency rates (assured by
PTCA) for all patients
Plasminogen-Activator AngioplastyPlasminogen-Activator AngioplastyCompatibility Trial (PACT)Compatibility Trial (PACT)
Ross AM, et al. J Am Coll Cardiol. 1999;34:1954-1962.
Eligible acute infarct patientsn=606ASA, IV heparin
t-PA50 mg bolus
Placebobolus
Immediate angiography
TIMI 3 TIMI 0, 1, 2
Second bolusof study drug
Immediateangioplasty
Follow-up angiogram 5-7 days, ETT 6 wk
Randomize
1519
33
28
0
20
40
60
80
Perc
ent T
IMI G
rade
2/
3 FL
ow
Placebo t-PA
TIMI 2TIMI 3
34.3
61
*All comparisons P<0.001.Ross AM, et al. J Am Coll Cardiol. 1999;34:1954-1962.
Patency of the Infarct Artery on Catheter Patency of the Infarct Artery on Catheter Laboratory Arrival (Core Laboratory) Laboratory Arrival (Core Laboratory)
94.6 92.8
79 76.6
15.6 16.2
86.7 82.8
0
20
40
60
80
100
TIMI 0,1 TIMI 0, 1 TIMI 0, 1 TIMI 2
Placebo t-PA
Adapted from Ross AM, et al. J Am Coll Cardiol. 1999;34:1954-1962.P=NS TIMI 2, 3 TIMI 3 TIMI 2 TIMI 3
Technical Results of PTCA: Technical Results of PTCA: Core Laboratory ResultsCore Laboratory Results
% o
f Pat
ient
s
62.4 57.9 54.7
0
20
40
60
80
TIMI 3 on cath lab arrival TIMI 3 on cath lab arrival Never had TIMI 3
Adapted from Ross AM, et al. J Am Coll Cardiol. 1999;34:1954-1962.
% C
onva
lesc
ent L
VEF
Convalescent LV Function By Patency Convalescent LV Function By Patency Group: Global Ejection FractionGroup: Global Ejection Fraction
P=0.004
Adverse Event t-PA Placebo P Value
Major bleeding 12.9% 13.5% 0.84
Stroke (any) 0.7% 0.7% 0.99
Intracranial hemorrhage 0.3% 0.3% 0.99
Emergency revascularization 7.3% 7.2% 0.98
Hospital death 3.6% 3.0% 0.64
30-day death 3.6% 3.3% 0.81
Adapted from Ross AM, et al. J Am Coll Cardiol. 1999;34:1954-1962.
PACT: PACT: AdverseAdverse Events Events
Summary: Pharmacologic/Mechanical Summary: Pharmacologic/Mechanical Combination TherapyCombination Therapy
•Safe: no increase in ICH, CABG, reocclusion, or repeat PTCA
•Mounting evidence of better clinical outcomes•May have special value in decreasing time
delay to revascularization associated with PTCA
•Outcomes best if artery open before PTCA