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 A. Greenberg, Sebastian T. Palmeri, Suzanne Crater, Kathleen Trollinger, Karen Hannan, Robert A. Harrington, Mitchell W. Krucoff

Research output: Contribution to journalArticle

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Abstract

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
Volume43
Issue number4
DOIs
StatePublished - Feb 18 2004

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Reperfusion
Biomarkers
Platelet Glycoprotein GPIIb-IIIa Complex
eptifibatide
tenecteplase
ST Elevation Myocardial Infarction
Angiography
Therapeutics
Ischemia
Myocardial Infarction
Mortality
Lead

Keywords

  • 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

  • Nursing(all)

Cite this

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

In: Journal of the American College of Cardiology, Vol. 43, No. 4, 18.02.2004, p. 549-556.

Research output: Contribution to journalArticle

Roe, Matthew T. ; Green, Cynthia L. ; Giugliano, Robert P. ; Gibson, C. Michael ; Baran, Kenneth ; Greenberg, Mark A. ; Palmeri, Sebastian T. ; Crater, Suzanne ; Trollinger, Kathleen ; Hannan, Karen ; Harrington, Robert A. ; Krucoff, Mitchell W. / 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. In: Journal of the American College of Cardiology. 2004 ; Vol. 43, No. 4. pp. 549-556.
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abstract = "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.",
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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 A.

AU - Palmeri, Sebastian T.

AU - Crater, Suzanne

AU - Trollinger, Kathleen

AU - Hannan, Karen

AU - Harrington, Robert A.

AU - Krucoff, Mitchell W.

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

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SP - 549

EP - 556

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

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