Related Experiment Videos
[Study of new thrombolytic agents in myocardial infarction: a multicenter randomized trial (APSAC versus rt-PA)]
J Cassagnes1, J Machecourt, J P Bassand
1Service de cardiologie, CHRU, Clermont-Ferrand.
Insights
This study found that both an isolated plasminogen streptokinase activator complex (APSAC) and tissue-type plasminogen activator (rt-PA) are equally effective in treating acute myocardial infarction. Researchers recommend adjusting rt-PA dosage based on patient weight.
Area of Science:
- Cardiology
- Pharmacology
- Emergency Medicine
Background:
- Acute myocardial infarction (AMI) requires prompt reperfusion therapy.
- Thrombolytic agents are crucial for restoring blood flow in AMI.
- Comparing the efficacy of different thrombolytics is essential for optimizing patient care.
Purpose of the Study:
- To compare the efficacy and safety of APSAC versus rt-PA in patients with acute myocardial infarction.
- To evaluate clinical outcomes, including mortality, side effects, arterial patency, left ventricular function, and infarct size.
Main Methods:
- A double-blind, placebo-controlled trial involving 183 patients with AMI.
- Administration of APSAC (30 MU) or rt-PA (10 mg bolus + 90 mg infusion) within 4 hours of symptom onset.
- Assessment of clinical evolution, adverse events, coronary artery patency, left ventricular function (angiography, angioscintigraphy), and infarct size.
Main Results:
- No significant difference in hospital mortality between APSAC (5 deaths) and rt-PA (7 deaths) groups.
- Comparable rates of adverse effects, particularly hemorrhage (APSAC: 11 patients, rt-PA: 9 patients).
- Similar arterial patency rates (APSAC: 72%, rt-PA: 76%) and comparable left ventricular function and infarct size between the groups.
Conclusions:
- APSAC and rt-PA demonstrate equivalent efficacy in the treatment of acute myocardial infarction.
- Both agents are associated with similar safety profiles regarding mortality and bleeding complications.
- The study suggests considering body weight-based dosing for rt-PA to potentially optimize treatment outcomes.
Abstract:
A hundred and eighty three patients with a primary myocardial infarction less than 4 hours old were included in a double blind trial versus placebo comparing an isolated plasminogen streptokinase activator complex (APSAC: 30 mu in 5 mn) and tissue type plasminogen activator (rt PA: 10 mg bolus followed by 90 mg in 130 mn). Clinical evolution, side effects, patency of the artery responsible for infarction, left ventricular contractile function (contrast angiography on the 7th day and angioscintigraphy on the 21st day) and infarct size were studied. The two groups were comparable in age (54 +/- 11 years), delay in randomisation (170 +/- 50 mn), infarct site and severity of cardiac failure. There was no significant difference in hospital mortality (7 in the rt PA group and 5 in the APSAC group) or in adverse effects (haemorrhage: rt PA: 9 patients, APSAC: 11 patients). The patency was 72% in the APSAC and 76% in the rt PA group. Left ventricular function and infarct size were comparable in the two groups: angiographic EF (0.50 +/- 0.1 in the APSAC and 0.52 +/- 0.1 in the rt PA group: NS); asynergic score (11.3 +/- 1.7 in the APSAC and 10.5 +/- 1.8 in the rt PA group: NS); infarct size (10.9 +/- 8.0 in the APSAC and 9.4 +/- 7.2 in the rt PA group: NS). This trial shows that these two thrombolytic agents have the same efficacy. The authors recommend adaptation of the dosage of rt PA to body weight.