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Coronary revascularization after intravenous tissue plasminogen-activator for unstable angina-pectoris - results of a randomized, double-blind, placebo-controlled trial

Academic Article
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Overview

authors

  • Topol, Eric
  • Nicklas, J. M.
  • Kander, N. H.
  • Walton, J. A.
  • Ellis, S. G.
  • Gorman, L.
  • Pitt, B.

publication date

  • September 1988

journal

  • American Journal of Cardiology  Journal

abstract

  • To determine the role of intravenous tissue plasminogen activator (t-PA) in unstable angina, it was compared with placebo in a randomized, double-blind trial. Forty patients with angina at rest and provocable ischemia (pacing induced) had baseline coronary angiography, study drug infusion and then repeat angiography at 20 +/- 9 hours. All patients received diltiazem, nitrates, beta blockers, aspirin and intravenous heparin. During study drug infusion (150 mg over 8 hours), refractory ischemia necessitating emergency bypass surgery (CABG) or coronary angioplasty (PTCA) occurred in 4 of 20 t-PA patients compared with 1 of 20 placebo patients (p = 0.21). Before discharge, revascularization for persistent, provocable ischemia and a residual stenosis greater than or equal to 60% was as follows: t-PA patients, 8 PTCA and 7 CABG; placebo patients, 11 PTCA and 8 CABG (p = 0.39). Quantitative angiographic percent diameter stenosis of the culprit artery at baseline and follow-up was: t-PA 71 +/- 17 and 63 +/- 22; placebo 70 +/- 19 and 67 +/- 22 (difference not significant). However, 3 t-PA patients compared with no placebo patients demonstrated an insignificant (less than 60% diameter) residual stenosis and averted PTCA (p = 0.14). There were no complications of PTCA in the 8 t-PA patients; in contrast, 3 of 11 placebo patients had abrupt closure, necessitating emergency CABG in 2 (p = 0.23). Thus, intravenous t-PA in unstable angina can eliminate the need for PTCA in a few patients, does not appear to decrease the overall or emergency rate of revascularization procedures and may facilitate the safety of PTCA.

subject areas

  • Angina Pectoris
  • Angina, Unstable
  • Angiography
  • Angioplasty, Balloon
  • Blood Transfusion
  • Clinical Trials as Topic
  • Coronary Angiography
  • Coronary Artery Bypass
  • Double-Blind Method
  • Hemorrhage
  • Humans
  • Injections, Intravenous
  • Postoperative Complications
  • Random Allocation
  • Tissue Plasminogen Activator
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Identity

International Standard Serial Number (ISSN)

  • 0002-9149

Digital Object Identifier (DOI)

  • 10.1016/0002-9149(88)90960-5

PubMed ID

  • 2970776
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Additional Document Info

start page

  • 368

end page

  • 371

volume

  • 62

issue

  • 7

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