Author + information
- Received October 20, 1986
- Revision received January 14, 1987
- Accepted January 26, 1987
- Published online July 1, 1987.
- Adam D. Timmis, MD, MRCP*,1,
- Brian Griffin, MB, MRCPI1,
- Jonathan C.P. Crick, Dphil, MRCP1 and
- Edgar Sowton, MD, FACC1
- ↵*Address for reprints: Adam D. Timmis Mb, Department of Cardiology. Guy's Hospital, St. Thomas' Street, London SE1 9RT, England.
Anisoylated plasminogen streptokinase activator complex (APSAC) is a new thrombolytic agent that is of interest because of its ease of administration as an intravenous bolus injection. This report describes the first double-blind, placebo-controlled evaluation of intravenous APSAC for coronary recanalization in acute myocardial infarction. Unequivocal documentation of recanalization was provided by coronary arteriography before and after the drug intervention. Forty patients with acute myocardial infarction underwent coronary arteriography 3.1 ± 1.2 hours after the onset of symptoms. This demonstrated occlusion of the infarct-related coronary artery in 29 patients who were then randomized to treatment with intravenous APSAC, 30 mg (n = 16), and placebo (n = 13) 3.3 ± 1.3 hours after the onset of symptoms.
Repeat arteriography 90 minutes later demonstrated recanalization of the infarct-related coronary artery in nine patients who had received APSAC compared with only one patient who had received placebo (56 versus 8%, p < 0.05). The 95% confidence limits for this 48% difference between the groups are 20 to 76%. Arteriography at 3 days showed persistent patency of all recanalized coronary arteries except one (APSAC group) and also showed late recanalization in another four patients, three of whom had received APSAC. In the patients who had a patent infarct-related coronary artery at the initial arteriographic study, patency was maintained throughout the study period regardless of whether the patient was randomized to APSAC (n = 4) or placebo (n = 7). Complications related to APSAC therapy were excessive bruising at the catheterization site in seven patients and minor sensitivity reactions in three.
These data confirm the thrombolytic efficacy of APSAC in acute myocardial infarction, and indicate that the drug may be used safely by the intravenous route with a 56% early recanalization rate.
- Received October 20, 1986.
- Revision received January 14, 1987.
- Accepted January 26, 1987.
- American College of Cardiology Foundation