Plasminogen Activator-Angioplasty Compatibility Trial - PACT
Reduced dose tPA + PTCA in acute MI
To evaluate the safety and efficacy of a reduced dose of the fibrinolytic agent tPA in combination with PTCA as the primary recanalization modality in acute MI.
Patients Screened: N/A
Patients Enrolled: 606
NYHA Class: Not reported
Mean Follow Up: 1 year
Mean Patient Age: average 58 years
Mean Ejection Fraction: No baseline assessment. See principal findings for predischarge data.
Presenting within 6 hours of onset and with ischemic symptoms >= 30 minutes and ST elevation >= 30 min and ST elevation >= 0.1mV in >= 2 limb leads or >= 0.2 mV in >= 2 contiguous leads
Age > 75 years, prior CVA or TIA, head trauma within 6 months, active bleeding or bleeding diasthesis, recent trauma or major surgery, prior bypass surgery, PTCA within 6 months, SBP >170 mmHg or DBP >110 mmHg, pregnant or lactating women
Predischarge ejection fraction
Culprit artery patency on cath lab arrival, PTCA technical results, complication rates, time to restored patency following PTCA
Precatheterization thrombolysis (tPA 50-mg bolus) or placebo followed by immediate coronary ngiography. If TIMI grade 3 flow was present, a second bolus of tPA 50 mg was given. If TIMI grade 0–2 flow was present, angioplasty was performed.
Initial angiography showed that the tPA group had better TIMI grade 3 flow (32.8% vs. 14.8%) and patency (TIMI grade 2 or 3; 61% vs 34%, p=0.001). Rescue and primary PTCA restored TIMI-3 flow in closed arteries equally (77% vs 79%). There was no significant difference between the groups in predischarge ejection fraction (primary end point) but EF was higher in those with TIMI 3 flow on cath lab arrival (62.4%). The small group of patients (12%) who had PTCA performed <1 hour after the tPA bolus also had better ejection fractions (62.5% vs 57.3%). Mortality rates (30 day) were 3.6% and 3.3% in the rt-PA and placebo groups, respectively (p=0.81). There were no significant differences between the two groups in the incidence of stroke (both 0.7%) or major bleeding (12.9% vs 13.5%)
In acute ST elevation MI, a reduced dose thrombolytic regimen followed by primary PTCA results in improved early patency and preserved LV function.
J Am Coll Cardiol 1999; 34: 1954-62.
Keywords: Thrombolytic Therapy, Stroke, Coronary Disease, Fibrinolytic Agents, Tissue Plasminogen Activator, Angioplasty, Balloon, Coronary
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