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Anistreplase versus alteplase in acute myocardial infarction: comparative effects on left ventricular function,
J L Anderson1, L C Becker, S G Sorensen
1Department of Medicine, University of Utah, Salt Lake City.
Insights
Anistreplase (APSAC) and alteplase (rt-PA) both effectively treat acute myocardial infarction. Alteplase showed a higher convalescent rest ejection fraction, but other outcomes like coronary patency and morbidity were similar.
Area of Science:
- Cardiology
- Thrombolytic Therapy
- Acute Myocardial Infarction Treatment
Background:
- Anistreplase (APSAC) is a new, easily administered thrombolytic agent.
- Alteplase (rt-PA) is a widely used, rapidly acting, fibrin-specific thrombolytic agent.
- Both are used for acute myocardial infarction (AMI).
Purpose of the Study:
- Compare anistreplase (APSAC) versus alteplase (rt-PA) in AMI patients.
- Evaluate effects on left ventricular function, morbidity, and coronary patency.
- Assess outcomes at 1 day and 1 month post-treatment.
Main Methods:
- Double-blind, randomized, multicenter trial.
- 325 patients with AMI (symptom duration ≤4h, ST elevation) received APSAC or rt-PA with aspirin and heparin.
- Outcomes included rest/exercise ejection fraction, clinical morbidity, and coronary artery patency at 1 day.
Main Results:
- Convalescent ejection fraction was higher with rt-PA (54.2% vs 51.3% predischarge, 54.8% vs 50.2% at 1 month).
- Exercise ejection fraction augmentation and exercise times were comparable.
- Coronary artery patency at 1 day was high and similar (89% APSAC, 86% rt-PA).
- Mortality and clinical events (stroke, heart failure, reinfarction) were comparable.
Conclusions:
- Both APSAC and rt-PA are effective for AMI.
- rt-PA demonstrated a higher convalescent rest ejection fraction.
- Other key outcomes including exercise function, morbidity, and early coronary patency were comparable between APSAC and rt-PA.
Objectives:
This double-blind, randomized, multicenter trial was designed to compare the effects of treatment with anistreplase (APSAC) and alteplase (rt-PA) on convalescent left ventricular function, morbidity and coronary artery patency at 1 day in patients with acute myocardial infarction.
Background:
Anistreplase (APSAC) is a new, easily administered thrombolytic agent recently approved for treatment of acute myocardial infarction. Alteplase (rt-PA) is a rapidly acting, relatively fibrin-specific thrombolytic agent that is currently the most widely used agent in the United States.
Methods:
Study entry requirements were age less than or equal to 75 years, symptom duration less than or equal to 4 h, ST segment elevation and no contraindications. The two study drugs, APSAC, 30 U/2 to 5 min, and rt-PA, 100 mg/3 h, were each given with aspirin (160 mg/day) and intravenous heparin. Prespecified end points were convalescent left ventricular function (rest/exercise), clinical morbidity and coronary artery patency at 1 day. A total of 325 patients were entered, stratified into groups with anterior (37%) or inferior or other (63%) acute myocardial infarction, randomized to receive APSAC or rt-PA and followed up for 1 month.
Results:
At entry, patient characteristics in the two groups were balanced. Convalescent ejection fraction at the predischarge study averaged 51.3% in the APSAC group and 54.2% in the rt-PA group (p less than 0.05); at 1 month, ejection fraction averaged 50.2% versus 54.8%, respectively (p less than 0.01). In contrast, ejection fraction showed similar augmentation with exercise at 1 month after APSAC (+4.3% points) and rt-PA (+4.6% points), and exercise times were comparable. Coronary artery patency at 1 day was high and similar in both groups (APSAC 89%, rt-PA 86%). Mortality (APSAC 6.2%, rt-PA 7.9%) and the incidence of other serious clinical events, including stroke, ventricular tachycardia, ventricular fibrillation, heart failure within 1 month, recurrent ischemia and reinfarction were comparable in the two groups; and mechanical interventions were applied with equal frequency. A combined clinical morbidity index was determined and showed a comparable overall outcome for the two treatments.
Conclusions:
Convalescent rest ejection fraction was high after both therapies but higher after rt-PA; other clinical outcomes, including exercise function, morbidity index, and 1-day coronary artery patency, were favorable and comparable after APSAC and rt-PA.