Affiliation:
1. the Medizinische Klinik III (Kardiologie) (C. Bode), Universita¨t Heidelberg (Germany); University of Texas Medical School (Houston) (R.W.S.); Klinikum der Universita¨t Homburg (Germany) (G.B.); Highline Community Hospital (C. Burnett), Seattle, Wash; Valley Medical Center (G.L.), Renton, Wash; St Francis Hospital (J.M.K.), Tulsa, Okla; Taylor Hospital (R.C.), Ridley Park, Pa; Sacred Heart General Hospital (L.G.C.), Eugene, Ore; Munroe Regional Medical Center (R.L.F.), Ocala, Fla; Memorial Medical...
Abstract
Background
The therapeutic benefit of thrombolytic therapy has been shown to correlate directly with completeness (TIMI grade 3 flow) and speed of reperfusion of the infarct-related coronary artery. The purpose of the RAPID II study was to determine whether a double-bolus regimen of reteplase, a recently developed deletion mutant of wild-type tissue plasminogen activator, could improve 90-minute coronary artery patency rates achieved with the most successful standard regimen, an “accelerated” front-loaded infusion of alteplase.
Methods and Results
Three hundred twenty-four patients with acute myocardial infarction were randomized to receive (along with intravenous heparin and aspirin) either a 10 plus 10 megaunits double bolus of reteplase or front-loaded alteplase. The primary end point of “patency at 90 minutes, graded according to the TIMI classification” was centrally assessed in a blinded fashion. Infarct-related coronary artery patency (TIMI grade 2 or 3) and complete patency (TIMI grade 3) at 90 minutes after the start of thrombolytic therapy were significantly higher in the reteplase-treated patients (TIMI grade 2 or 3: 83.4% versus 73.3% for front-loaded alteplase-treated patients,
P
=.03; TIMI grade 3: 59.9% versus 45.2%,
P
=.01). At 60 minutes, the incidence of both, patency and complete patency, was also significantly higher in reteplase-treated patients (reteplase versus alteplase, TIMI grade 2 or 3: 81.8% versus 66.1%,
P
=.01; TIMI grade 3: 51.2% versus 37.4%,
P
<.03). Reteplase-treated patients required fewer acute additional coronary interventions (13.6% versus 26.5%,
P
<.01), and 35-day mortality was 4.1% for reteplase and 8.4% for alteplase (
P
=NS). There were no significant differences between reteplase and alteplase in bleedings requiring a transfusion (12.4% versus 9.7%) or hemorrhagic stroke (1.2% versus 1.9%).
Conclusions
Reteplase, when given as a double bolus of 10 plus 10 megaunits to patients with acute myocardial infarction, achieves significantly higher rates of early reperfusion of the infarct-related coronary artery and requires significantly fewer acute coronary interventions than front-loaded alteplase without an apparent increased risk of complications.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
313 articles.
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