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Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction

BACKGROUND: Impaired microcirculatory reperfusion worsens prognosis following acute ST‐segment–elevation myocardial infarction. In the T‐TIME (A Trial of Low‐Dose Adjunctive Alteplase During Primary PCI) trial, microvascular obstruction on cardiovascular magnetic resonance imaging did not differ wit...

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Autores principales: Maznyczka, Annette M., McCartney, Peter J., Oldroyd, Keith G., Lindsay, Mitchell, McEntegart, Margaret, Eteiba, Hany, Rocchiccioli, Paul, Good, Richard, Shaukat, Aadil, Robertson, Keith, Kodoth, Vivek, Greenwood, John P., Cotton, James M., Hood, Stuart, Watkins, Stuart, Macfarlane, Peter W., Kennedy, Julie, Tait, R. Campbell, Welsh, Paul, Sattar, Naveed, Collison, Damien, Gillespie, Lynsey, McConnachie, Alex, Berry, Colin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7033872/
https://www.ncbi.nlm.nih.gov/pubmed/31986989
http://dx.doi.org/10.1161/JAHA.119.014066
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author Maznyczka, Annette M.
McCartney, Peter J.
Oldroyd, Keith G.
Lindsay, Mitchell
McEntegart, Margaret
Eteiba, Hany
Rocchiccioli, Paul
Good, Richard
Shaukat, Aadil
Robertson, Keith
Kodoth, Vivek
Greenwood, John P.
Cotton, James M.
Hood, Stuart
Watkins, Stuart
Macfarlane, Peter W.
Kennedy, Julie
Tait, R. Campbell
Welsh, Paul
Sattar, Naveed
Collison, Damien
Gillespie, Lynsey
McConnachie, Alex
Berry, Colin
author_facet Maznyczka, Annette M.
McCartney, Peter J.
Oldroyd, Keith G.
Lindsay, Mitchell
McEntegart, Margaret
Eteiba, Hany
Rocchiccioli, Paul
Good, Richard
Shaukat, Aadil
Robertson, Keith
Kodoth, Vivek
Greenwood, John P.
Cotton, James M.
Hood, Stuart
Watkins, Stuart
Macfarlane, Peter W.
Kennedy, Julie
Tait, R. Campbell
Welsh, Paul
Sattar, Naveed
Collison, Damien
Gillespie, Lynsey
McConnachie, Alex
Berry, Colin
author_sort Maznyczka, Annette M.
collection PubMed
description BACKGROUND: Impaired microcirculatory reperfusion worsens prognosis following acute ST‐segment–elevation myocardial infarction. In the T‐TIME (A Trial of Low‐Dose Adjunctive Alteplase During Primary PCI) trial, microvascular obstruction on cardiovascular magnetic resonance imaging did not differ with adjunctive, low‐dose, intracoronary alteplase (10 or 20 mg) versus placebo during primary percutaneous coronary intervention. We evaluated the effects of intracoronary alteplase, during primary percutaneous coronary intervention, on the index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio. METHODS AND RESULTS: A prespecified physiology substudy of the T‐TIME trial. From 2016 to 2017, patients with ST‐segment–elevation myocardial infarction ≤6 hours from symptom onset were randomized in a double‐blind study to receive alteplase 20 mg, alteplase 10 mg, or placebo infused into the culprit artery postreperfusion, but prestenting. Index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio were measured after percutaneous coronary intervention. Cardiovascular magnetic resonance was performed at 2 to 7 days and 3 months. Analyses in relation to ischemic time (<2, 2–4, and ≥4 hours) were prespecified. One hundred forty‐four patients (mean age, 59±11 years; 80% male) were prospectively enrolled, representing 33% of the overall population (n=440). Overall, index of microcirculatory resistance (median, 29.5; interquartile range, 17.0–55.0), coronary flow reserve(1.4 [1.1–2.0]), and resistive reserve ratio (1.7 [1.3–2.3]) at the end of percutaneous coronary intervention did not differ between treatment groups. Interactions were observed between ischemic time and alteplase for coronary flow reserve (P=0.013), resistive reserve ratio (P=0.026), and microvascular obstruction (P=0.022), but not index of microcirculatory resistance. CONCLUSIONS: In ST‐segment–elevation myocardial infarction with ischemic time ≤6 hours, there was overall no difference in microvascular function with alteplase versus placebo. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294.
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spelling pubmed-70338722020-02-27 Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction Maznyczka, Annette M. McCartney, Peter J. Oldroyd, Keith G. Lindsay, Mitchell McEntegart, Margaret Eteiba, Hany Rocchiccioli, Paul Good, Richard Shaukat, Aadil Robertson, Keith Kodoth, Vivek Greenwood, John P. Cotton, James M. Hood, Stuart Watkins, Stuart Macfarlane, Peter W. Kennedy, Julie Tait, R. Campbell Welsh, Paul Sattar, Naveed Collison, Damien Gillespie, Lynsey McConnachie, Alex Berry, Colin J Am Heart Assoc Original Research BACKGROUND: Impaired microcirculatory reperfusion worsens prognosis following acute ST‐segment–elevation myocardial infarction. In the T‐TIME (A Trial of Low‐Dose Adjunctive Alteplase During Primary PCI) trial, microvascular obstruction on cardiovascular magnetic resonance imaging did not differ with adjunctive, low‐dose, intracoronary alteplase (10 or 20 mg) versus placebo during primary percutaneous coronary intervention. We evaluated the effects of intracoronary alteplase, during primary percutaneous coronary intervention, on the index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio. METHODS AND RESULTS: A prespecified physiology substudy of the T‐TIME trial. From 2016 to 2017, patients with ST‐segment–elevation myocardial infarction ≤6 hours from symptom onset were randomized in a double‐blind study to receive alteplase 20 mg, alteplase 10 mg, or placebo infused into the culprit artery postreperfusion, but prestenting. Index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio were measured after percutaneous coronary intervention. Cardiovascular magnetic resonance was performed at 2 to 7 days and 3 months. Analyses in relation to ischemic time (<2, 2–4, and ≥4 hours) were prespecified. One hundred forty‐four patients (mean age, 59±11 years; 80% male) were prospectively enrolled, representing 33% of the overall population (n=440). Overall, index of microcirculatory resistance (median, 29.5; interquartile range, 17.0–55.0), coronary flow reserve(1.4 [1.1–2.0]), and resistive reserve ratio (1.7 [1.3–2.3]) at the end of percutaneous coronary intervention did not differ between treatment groups. Interactions were observed between ischemic time and alteplase for coronary flow reserve (P=0.013), resistive reserve ratio (P=0.026), and microvascular obstruction (P=0.022), but not index of microcirculatory resistance. CONCLUSIONS: In ST‐segment–elevation myocardial infarction with ischemic time ≤6 hours, there was overall no difference in microvascular function with alteplase versus placebo. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294. John Wiley and Sons Inc. 2020-01-28 /pmc/articles/PMC7033872/ /pubmed/31986989 http://dx.doi.org/10.1161/JAHA.119.014066 Text en © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Maznyczka, Annette M.
McCartney, Peter J.
Oldroyd, Keith G.
Lindsay, Mitchell
McEntegart, Margaret
Eteiba, Hany
Rocchiccioli, Paul
Good, Richard
Shaukat, Aadil
Robertson, Keith
Kodoth, Vivek
Greenwood, John P.
Cotton, James M.
Hood, Stuart
Watkins, Stuart
Macfarlane, Peter W.
Kennedy, Julie
Tait, R. Campbell
Welsh, Paul
Sattar, Naveed
Collison, Damien
Gillespie, Lynsey
McConnachie, Alex
Berry, Colin
Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction
title Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction
title_full Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction
title_fullStr Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction
title_full_unstemmed Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction
title_short Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction
title_sort effects of intracoronary alteplase on microvascular function in acute myocardial infarction
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7033872/
https://www.ncbi.nlm.nih.gov/pubmed/31986989
http://dx.doi.org/10.1161/JAHA.119.014066
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