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Reperfusion, patency and reocclusion with anistreplase (APSAC) in acute myocardial infarction
1Department of Internal Medicine, University of Utah, Salt Lake City.
Insights
Anisoylated plasminogen streptokinase activator complex (APSAC) demonstrates significant reperfusion and patency rates in acute myocardial infarction (MI) patients. Further evaluation is needed to assess reocclusion and reinfarction rates for net therapeutic success.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Reestablishing coronary blood flow is crucial for thrombolytic therapy benefits.
- Evaluating new thrombolytic therapies requires measuring reperfusion, patency, and reocclusion rates.
Purpose of the Study:
- To assess the efficacy of anisoylated plasminogen streptokinase activator complex (APSAC) in acute myocardial infarction (MI).
- To compare APSAC with control/placebo for absolute efficacy and with streptokinase for relative efficacy.
Main Methods:
- Pooled analysis of angiographic reperfusion and patency studies.
- Utilized creatine kinase curve peaking as an indicator of patency.
- Monitored reocclusion and reinfarction rates in patients with initially patent arteries.
Main Results:
- APSAC achieved angiographic reperfusion in 55% of acute MI patients within 6 hours.
- 69% of patients showed an open infarct-related artery 1-4 hours after APSAC therapy.
- A 63% patency rate was observed using creatine kinase peaking in 387 patients.
Conclusions:
- APSAC demonstrates considerable efficacy in achieving coronary reperfusion and patency in acute MI.
- Reocclusion and reinfarction rates are critical factors that diminish the initial success of thrombolytic therapies and require careful consideration.
Abstract:
Because the reestablishment of coronary blood flow is believed to be central to the benefit of thrombolytic therapy, measurements of reperfusion (i.e., angiography before and after therapy), patency (i.e., angiography after therapy) and reocclusion rates are important to the evaluation of new thrombolytic therapies. For anisoylated plasminogen streptokinase activator complex (APSAC, anistreplase), comparisons have been made with control or placebo therapies to assess absolute efficacy, and with streptokinase to assess relative efficacy. In pooled experience from reperfusion studies, APSAC (30 U over 2 to 5 minutes) led to angiographic reperfusion in 55% of patients (98 of 177) who had symptoms of acute myocardial infarction (MI) for less than 6 hours. Among 107 patients treated with APSAC in angiographic patency studies, 69% (74) showed an open infarct-related artery 1 to 4 hours after therapy. (Patency rates are generally 10 to 20% greater than reperfusion rates, because some patients with acute MI may have a patent [subtotally occluded or spontaneously reperfused] infarct-related artery when entered into patency studies.) Using early peaking (less than or equal to 15 hours) of the creatine kinase curve as an indicator, a patency rate of 63% was observed among 387 patients treated with APSAC. The initial success rate with thrombolytic therapies is diminished by the rates of reocclusion and reinfarction, which must be accounted for in determining the net success of therapy. In 6 studies, a total of 87 patients with initially patent arteries after APSAC returned for reevaluation in 1 to 3 days.(ABSTRACT TRUNCATED AT 250 WORDS)