Anistreplase versus alteplase in acute myocardial infarction: Comparative effects on left ventricular function, morbidity and 1-day coronary artery patency

Jeffrey L. Anderson*, Lewis C. Becker, Sherman G. Sorensen, Labros A. Karagounis, Kevin F. Browne, Prediman K. Shah, Douglas C. Morris, Dan J. Fintel, Hiltrud S. Mueller, Allan M. Ross, Suzanne M. Hall, Jack C. Askins, Andrew J. Doorey, Cindy L. Grines, Fidela L. Moreno, Victor J. Marder

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Objectives. This double-blind, randomized, multicenler trial was designed to compare the effects of treatment with anistreplase (APSAC) and alteplase (rt-PA) on convalescent left ventricular function, morbidity and coronary artery patency at 1 day in patients with acute myocardial infarction. Background. Anistreplase (APSAC) is a new, easily administered thrombolytk agent recently approved for treatment of acute myocardial infarction. Alteplase (rt-PA) is a rapidly acting, relatively fibrin-specific thrombolytic agent that is currently the most widely used agent in the United States. Methods. Study entry requirements were age ≤ 75 years, symptom duration ≤ 4 h, ST segment elevation and no contraindications. The two study drugs, APSAC, 30 U/2 to S min, and rt-PA, 100 mg/3 h, were each given with aspirin (160 mg/day) and intravenous heparin. Prespecified end points were convalescent left ventrkular function (rest/exercise), clinical morbidity and coronary artery patency at 1 day. A total of 325 patients were entered, stratified into groups with anterior (37%) or inferior or other (63%) acute myocardial infarction, randomized to receive APSAC or rt-PA and followed up for 1 month. Results. At entry, patient characteristics in the two groups were balanced. Convalescent ejection fraction at the predischarge study averaged 51.3% in the APSAC group and 54.2% in the rt-PA group (p < 0.05); at 1 month, ejection fraction averaged 50.2% versus 54.8%, respectively (p < 0.61). In contrast, ejection fraction showed similar augmentation with exercise at 1 month after APSAC (+4.3% points) and rt-PA (+4.6% points), and exercise times were comparable. Coronary artery patency at 1 day was high and similar in berth groups (APSAC 89%, rt-PA 86%). Mortality (APSAC 6.2%, rt-PA 7.9%) and the incidence of other serious clinical events, including stroke, ventricular tachycardia, ventricular fibrillation, heart failure within 1 month, recurrent ischemia and reinfarelion were comparable in the two groups; and mechanical interventions were applied with equal frequency. A combined clinical morbidity index was determined and showed a comparable overall outcome for the two treatments. Conclusions. Convalescent rest ejection fraction was high after both therapies but higher after rt-PA; other clinical outcomes, including exercise function, morbidity index, and 1-day coronary artery patency, were favorable and comparable after APSAC and rt-PA.

Original languageEnglish (US)
Pages (from-to)753-766
Number of pages14
JournalJournal of the American College of Cardiology
Volume20
Issue number4
DOIs
StatePublished - Oct 1992

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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