TY - JOUR
T1 - Improved speed and stability of ST-segment recovery with reduced-dose tenecteplase and eptifibatide compared with full-dose tenecteplase for acute ST-segment elevation myocardial infarction
AU - Roe, Matthew T.
AU - Green, Cynthia L.
AU - Giugliano, Robert P.
AU - Gibson, C. Michael
AU - Baran, Kenneth
AU - Greenberg, Mark
AU - Palmeri, Sebastian T.
AU - Crater, Suzanne
AU - Trollinger, Kathleen
AU - Hannan, Karen
AU - Harrington, Robert A.
AU - Krucoff, Mitchell W.
N1 - Funding Information:
This study was funded from research grants from Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, and Schering-Plough Research Institute, Kenilworth, New Jersey.
PY - 2004/2/18
Y1 - 2004/2/18
N2 - OBJECTIVES: This sub-study of the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial evaluated of the impact of combination reperfusion therapy with reduced-dose tenecteplase plus eptifibatide on continuous ST-segment recovery and angiographic results. BACKGROUND: Combination therapy with reduced-dose fibrinolytics and glycoprotein IIb/IIIa inhibitors for ST-segment elevation myocardial infarction improves biomarkers of reperfusion success but has not reduced mortality when compared with full-dose fibrinolytics. METHODS: We evaluated 140 patients enrolled in the INTEGRITI trial with 24-h continuous 12-lead ST-segment monitoring and angiography at 60 min. The dose-combination regimen of 50% of standard-dose tenecteplase (0.27 μg/kg) plus high-dose eptifibatide (2 boluses of 180 μg/kg separated by 10 min, 2.0 μg/kg/min infusion) was compared with full-dose tenecteplase (0.53 μg/kg). RESULTS: The dose-confirmation regimen of reduced-dose tenecteplase plus high-dose eptifibatide was associated with a faster median time to stable ST-segment recovery (55 vs. 98 min, p = 0.06), improved stable ST-segment recovery by 2 h (89.6% vs. 67.7%, p = 0.02), and less recurrent ischemia (34.0% vs. 57.1%, p = 0.05) when compared with full-dose tenecteplase. Continuously updated ST-segment recovery analyses demonstrated a modest trend toward greater ST-segment recovery at 30 min (57.7% vs. 40.6%, p = 0.13) and 60 min (82.7% vs. 65.6%, p = 0.08) with this regimen. These findings correlated with improved angiographic results at 60 min. CONCLUSIONS: Combination therapy with reduced-dose tenecteplase and eptifibatide leads to faster, more stable ST-segment recovery and improved angiographic flow patterns, compared with full-dose tenecteplase. These findings question the relationship between biomarkers of reperfusion success and clinical outcomes.
AB - OBJECTIVES: This sub-study of the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial evaluated of the impact of combination reperfusion therapy with reduced-dose tenecteplase plus eptifibatide on continuous ST-segment recovery and angiographic results. BACKGROUND: Combination therapy with reduced-dose fibrinolytics and glycoprotein IIb/IIIa inhibitors for ST-segment elevation myocardial infarction improves biomarkers of reperfusion success but has not reduced mortality when compared with full-dose fibrinolytics. METHODS: We evaluated 140 patients enrolled in the INTEGRITI trial with 24-h continuous 12-lead ST-segment monitoring and angiography at 60 min. The dose-combination regimen of 50% of standard-dose tenecteplase (0.27 μg/kg) plus high-dose eptifibatide (2 boluses of 180 μg/kg separated by 10 min, 2.0 μg/kg/min infusion) was compared with full-dose tenecteplase (0.53 μg/kg). RESULTS: The dose-confirmation regimen of reduced-dose tenecteplase plus high-dose eptifibatide was associated with a faster median time to stable ST-segment recovery (55 vs. 98 min, p = 0.06), improved stable ST-segment recovery by 2 h (89.6% vs. 67.7%, p = 0.02), and less recurrent ischemia (34.0% vs. 57.1%, p = 0.05) when compared with full-dose tenecteplase. Continuously updated ST-segment recovery analyses demonstrated a modest trend toward greater ST-segment recovery at 30 min (57.7% vs. 40.6%, p = 0.13) and 60 min (82.7% vs. 65.6%, p = 0.08) with this regimen. These findings correlated with improved angiographic results at 60 min. CONCLUSIONS: Combination therapy with reduced-dose tenecteplase and eptifibatide leads to faster, more stable ST-segment recovery and improved angiographic flow patterns, compared with full-dose tenecteplase. These findings question the relationship between biomarkers of reperfusion success and clinical outcomes.
KW - Corrected TIMI frame count
KW - Electrocardiogram/electrocardiographic
KW - Glycoprotein
KW - Infarct-related artery
KW - Integrilin and Tenecteplase in Acute Myocardial Infarction trial
KW - Ischemia Monitoring Core Laboratory
KW - Percutaneous coronary intervention
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U2 - 10.1016/j.jacc.2003.09.039
DO - 10.1016/j.jacc.2003.09.039
M3 - Article
C2 - 14975462
AN - SCOPUS:10744226447
SN - 0735-1097
VL - 43
SP - 549
EP - 556
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -