Low-Dose Alteplase During Primary Percutaneous Coronary Intervention According to Ischemic Time

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:75

Article

McCartney, Peter J.^1,2  Maznyczka, Annette M.^1,2  Eteiba, Hany^1,2  McEntegart, Margaret^1,2  Oldroyd, Keith G.²  Greenwood, John P.^3,4  Maredia, Neil⁵  Schmitt, Matthias⁶  McCann, Gerry P.^7,8  Fairbairn, Timothy⁹  McAlindon, Elisa¹⁰  Tait, Campbell¹¹  Welsh, Paul¹  Sattar, Naveed¹  Orchard, Vanessa²  Corcoran, David¹  Ford, Thomas J.^1,12  Radjenovic, Aleksandra¹  Ford, Ian¹³  McConnachie, Alex¹³  Berry, Colin^1,2 

[1] Univ Glasgow, Glasgow Cardiovasc Res Ctr, British Heart Fdn, Glasgow, Lanark, Scotland

[2] Golden Jubilee Natl Hosp, West Scotland Heart & Lung Ctr, Clydebank, England

[3] Univ Leeds, Leeds, W Yorkshire, England

[4] Leeds Teaching Hosp Natl Hlth Serv NHS Trust, Leeds, W Yorkshire, England

[5] South Tees Hosp NHS Fdn Trust, Middlesbrough, Cleveland, England

[6] Manchester Univ NHS Fdn Trust, Manchester, Lancs, England

[7] Univ Leicester, Leicester, Leics, England

[8] Natl Inst Hlth Res Leicester, Biomed Res Ctr, Leicester, Leics, England

[9] Liverpool Heart & Chest Hosp NHS Fdn Trust, Liverpool, Merseyside, England

[10] Royal Wolverhampton NHS Trust, New Cross Hosp, Wolverhampton, England

[11] Royal Infirm, Dept Hematol, Glasgow, Lanark, Scotland

[12] Gosford Hosp, Dept Cardiol, Gosford, NSW, Australia

[13] Univ Glasgow, Inst Hlth & Wellbeing, Robertson Ctr Biostat, Glasgow, Lanark, Scotland

关键词: fibrinolysis;    microvascular obstruction;    myocardial hemorrhage;    primary percutaneous coronary intervention;    ST-segment elevation myocardial infarction;   

DOI  :  10.1016/j.jacc.2020.01.041

来源: Elsevier

【 摘 要 】

BACKGROUND Microvascular obstruction affects one-half of patients with ST-segment elevation myocardial infarction and confers an adverse prognosis. OBJECTIVES This study aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intracoronary atteptase infused early after coronary reperfusion associates with ischemic time. METHODS This study was conducted in a prospective, multicenter, parallel group, 1:1:1 randomized, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified subgroup of interest. Between March 17, 2016, and December 21, 2017, 440 patients, presenting with ST-segment elevation myocardial infarction within 6 h of symptom onset (<2 h, n = 107; >= 2 h but <4 h, n 235;>= 4 h to 6 h, n = 98), were enrolled at 11 U.K. hospitals. Partidpants were randomly assigned to treatment with placebo (n = 151), atteptase 10 mg (n = 144), or atteptase 20 mg (n 145). The primary outcome was the amount of microvascular obstruction (MVO) (percentage of left ventricular mass) quantified by cardiac magnetic resonance imaging at 2 to 7 days (available for 396 of 440). RESULTS Overall, there was no assodation between atteptase dose and the extent of MVO (p for trend = 0.128). However, in patients with an ischemic time >= 4 to 6 h, atteptase increased the mean extent of MVO compared with placebo: 1.14% (placebo) versus 311% (10 mg) versus 5.20% (20 mg); p 0.009 for the trend. The interaction between ischemic time and atteptase dose was statistically significant (p = 0.018). CONCLUSION In patients presenting with ST-segment elevation myocardial infarction and an ischemic time >= 4 to 6 h, adjunctive treatment with low-dose intracoronary atteptase during primary percutaneous coronary intervention was associated with increased MVO. Intracoronary atteptase may be harmful for this subgroup. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

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