[Alteplase in acute coronary syndromes]

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Context:

• ST-elevation myocardial infarction (STEMI) management is time-sensitive.
• Primary angioplasty programs require effective reperfusion strategies.
• Current guidelines recommend specific anticoagulation regimens alongside thrombolytics.

Purpose:

• To assess the safety and security of two alteplase infusion protocols (100 mg/hr vs. 50 mg/30 min) in STEMI patients undergoing percutaneous coronary intervention (PCI).
• To evaluate alteplase safety in conjunction with unfractionated heparin and enoxaparin.
• To analyze outcomes in a real-world cardiology hospital setting with a 24/7 primary angioplasty program.

Summary:

• The REALSICA II registry prospectively enrolled 103 STEMI patients.
• Seventy-two patients received a one-hour 100 mg alteplase infusion, while 31 received a 50 mg/30 min infusion to facilitate PCI.
• No intracranial hemorrhage occurred; overall cardiovascular mortality was 11%. ECG reperfusion was observed in 59% and TIMI III flow in 19% of the PCI group. Patients receiving PCI had low rates of recurrent ischemia and reinfarction.

Impact:

• The one-hour alteplase infusion demonstrated safety in uncomplicated STEMI patients when used with standard heparin and enoxaparin.
• The accelerated 30-minute infusion regimen for PCI in complicated STEMI cases was linked to higher hemorrhagic complications, suggesting a need for further research.
• Findings inform clinical practice regarding thrombolytic therapy selection and administration in STEMI patients.