Clinical cardiology
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Clinical cardiology · Mar 1990
Randomized Controlled Trial Multicenter Study Clinical TrialTolerance and complications in a multicenter trial of intravenous APSAC and intracoronary streptokinase in acute myocardial infarction.
Adverse events data of a randomized, multicenter, angiographically controlled trial of intracoronary streptokinase and intravenous anistreplase, or anisoylated plasminogen streptokinase activator complex (APSAC) are presented. The frequency of severe adverse events is similar for streptokinase and anistreplase; no unexpected adverse experiences were reported with either drug. The most frequently encountered side effect was bleeding, overwhelmingly from the groin puncture site from angiography.
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Clinical cardiology · Mar 1990
Randomized Controlled Trial Comparative Study Clinical TrialVariability of thrombolytic coronary reperfusion: an angiographic study of streptokinase and anistreplase.
A total of 1,615 angiographic readings in 240 patients with acute myocardial infarction were analyzed from a randomized trial of intravenous anistreplase (Eminase), also known as anisoylated plasminogen streptokinase activator complex (APSAC), versus intracoronary streptokinase. Coronary arteriography was performed at baseline and at 15, 30, 45, 60, 75, and 90 minutes after drug infusion. Coronary flow in the infarct-related artery was defined using the TIMI criteria. ⋯ All of these changes in flow were statistically more common for the circumflex coronary artery and early treatment (less than 4 h), but did not differ for anistreplase or streptokinase. We conclude that frequent alterations in coronary blood flow occur early during reperfusion therapy and that these findings may explain reports with varying results of thrombolytic therapy. Any angiographic assessment of thrombolytic drug efficacy should take these variations as well as interobserver variability into account.
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Clinical cardiology · Mar 1990
Multicenter Study Clinical Trial Controlled Clinical TrialAngiographic assessment of patency and reocclusion: preliminary results of the Dutch APSAC Reocclusion Multicenter Study (ARMS).
The main objective of the ARMS (APSAC Reocclusion Multicenter Study) trial was to obtain patency and reocclusion data. In an open multicenter study, a total of 156 patients were treated with 30 U of anistreplase or anisoylated plasminogen streptokinase activator complex (APSAC) within 4 h after onset of pain. Patency of the infarct-related vessel was assessed by coronary angiography performed 90 minutes after anistreplase administration. ⋯ The preliminary data of the first 148 patients indicate that the patency rate at 90 min was 73-75% and the reocclusion rate at 24 h was 4%. This patency rate corresponds with previous studies. The low reocclusion rate is noteworthy and probably reflects the prolonged action of anistreplase.
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Clinical cardiology · Mar 1990
ReviewRole of the emergency department in decreasing the time to thrombolytic therapy in acute myocardial infarction.
Delay from the onset of acute myocardial infarction (AMI) symptoms to initiation of thrombolytic therapy can be reduced by improving patient recognition of AMI symptoms and encouraging speedier action in seeking medical assistance and improving the time it takes for medical personnel to evaluate the patient's symptoms and initiate appropriate therapy. Attempts to improve patient response to AMI symptoms have met with limited success. Prehospital administration of thrombolytic drugs may be of value, but many AMI patients are not transported by the emergency medical services system. ⋯ Unfortunately, much of what is known about the time sequence of ED thrombolytic therapy in the United States comes from organized trials in a small number of centers. Little is known about how often non-ED physicians participate in the decision-making process (either in person or by phone consultation), or how many delays are potentially avoidable. Current evidence suggests that preestablished ED treatment plans and protocols can reduce the time delay for many patients who present with AMI, especially if paramedics can transmit diagnostic quality ECGs to the hospital.