1. Tissue plasminogen activator in refractory unstable angina. A randomized double-blind placebo-controlled trial in patients with refractory unstable angina and subsequent angioplasty.
- Author
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van den Brand M, van Zijl A, Geuskens R, de Feyter PJ, Serruys PW, and Simoons ML
- Subjects
- Adult, Aged, Angina, Unstable etiology, Angina, Unstable therapy, Coronary Angiography, Coronary Artery Disease complications, Coronary Artery Disease therapy, Coronary Thrombosis complications, Coronary Thrombosis diagnostic imaging, Coronary Thrombosis drug therapy, Creatine Kinase blood, Double-Blind Method, Female, Hemorrhage etiology, Humans, Infusions, Intravenous, Male, Middle Aged, Myocardial Infarction enzymology, Myocardial Infarction etiology, Recurrence, Tissue Plasminogen Activator administration & dosage, Tissue Plasminogen Activator adverse effects, Treatment Outcome, Angina, Unstable drug therapy, Angioplasty, Balloon, Coronary, Coronary Artery Disease drug therapy, Tissue Plasminogen Activator therapeutic use
- Abstract
To evaluate the effect of recombinant tissue plasminogen activator (alteplase) on the clinical course, angiographic changes and the outcome of subsequent coronary angioplasty, 36 patients with angina at rest, despite bedrest and medical treatment including heparin, and with concomitant ECG changes, were studied. After diagnostic angiography, patients were randomized to receive either alteplase 100 mg in 3 h (19 patients), or placebo (17 patients). The mean interval between qualifying anginal episode and initial angiography was 10 and 9 h for the alteplase and placebo group, respectively. Angiography was repeated and angioplasty was performed within 24 hours. Between the first and the second angiogram, five patients in the alteplase and seven in the placebo group had recurrent ischaemic episodes, while four alteplase and three placebo patients showed signs of myocardial necrosis (creatine kinase (CK) rise greater than or equal to twice the upper limit for normal). Intracoronary clots were recognized in three alteplase patients and one placebo patient at the first angiogram, while two alteplase patients and one placebo patient showed total occlusion of the ischaemic-related vessel. After infusion, thrombi were present in four alteplase patients and one placebo patient, and total occlusion in three alteplase patients and one placebo patient. Quantitative coronary angiography showed no change in the percentage diameter stenosis of the ischaemia-related segment after drug infusion, (alteplase 67 +/- 16 to 69 +/- 16%; placebo 65 +/- 11 to 63 +/- 12%). Angioplasty was successful in 14 of 19 alteplase and 14 of 16 placebo patients.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1991
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