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

Matthew T. Roe, Cynthia L. Green, Robert P. Giugliano, C. Michael Gibson, Kenneth Baran, Mark Greenberg, Sebastian T. Palmeri, Suzanne Crater, Kathleen Trollinger, Karen Hannan, Robert A. Harrington, Mitchell W. Krucoff

Research output: Contribution to journalArticle

21 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)549-556
Number of pages8
JournalJournal of the American College of Cardiology
Issue number4
Publication statusPublished - Feb 18 2004



  • Corrected TIMI frame count
  • Electrocardiogram/electrocardiographic
  • Glycoprotein
  • Infarct-related artery
  • Integrilin and Tenecteplase in Acute Myocardial Infarction trial
  • Ischemia Monitoring Core Laboratory
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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