@article{69b3a09d770d4ed29ddaa9d518717e89,
title = "Tenecteplase and tirofiban in ST-segment elevation acute myocardial infarction: Results of a randomized trial",
abstract = "Background: The combination of older reduced-dose fibrinolytic agents and platelet glycoprotein IIb/IIIa inhibitors has shown modest improvements in reperfusion and more striking improvements in ST-segment resolution after acute myocardial infarction. We performed a multicenter dose-ranging study of reduced doses of a newer fibrinolytic (tenecteplase) combined with tirofiban, a glycoprotein IIb/IIIa inhibitor. Methods: The first goal of the trial was to identify a dose or doses of tirofiban that, when combined with reduced-dose tenecteplase, would result in a higher incidence of Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow at 60 minutes versus full-dose tenecteplase alone. The second goal was to assess whether the optimum dose(s) from the first stage also would result in greater resolution of ST-segment elevation. Results: In all, 409 patients aged 18 to 75 years with myocardial infarction were enrolled. The incidence of TIMI grade 3 flow at 60 minutes did not differ significantly among dose groups, ranging from 50% to 68%. The corrected TIMI frame count likewise did not differ substantially (range 34-42). More patients given combined therapy had complete resolution of ST-segment elevation at 60 minutes compared with patients given tenecteplase alone. Major bleeding was infrequent, and no strokes occurred. Based on angiographic results of the first stage, the second planned stage of the study was not performed. Conclusions: Although combination therapies were not associated with increased reperfusion compared with full-dose tenecteplase alone, similar TIMI flow grades were achieved despite reductions in tenecteplase doses. ST-segment resolution was more rapid and complete with combination therapy versus full-dose tenecteplase, suggesting enhanced microcirculatory perfusion to the infarct zone in this dose-ranging trial.",
author = "Ohman, {E. Magnus} and {Van De Werf}, Frans and Antman, {Elliott M.} and Califf, {Robert M.} and {de Lemos}, {James A} and Gibson, {C. Michael} and Oliverio, {Renee L.} and Lynn Harrelson and Carolyn McCabe and Peter DiBattiste and Eugene Braunwald",
note = "Funding Information: Angiographic Core Laboratory, Moffitt Hospital, University of California San Francisco: C.M. Gibson, K. Ryan, S. Murphy. Duke Clinical Research Institute: R.M. Califf, T. Demby-Ulmer, L. Harrelson, E. Hawkins, M. Molina, R. Oliverio, K. Stevens. Electrocardiographic Core Laboratory, TIMI Group : J.A. de Lemos Genentech, Inc: H.V. Barron. Leuven Coordinating Center: W. Desmet, K. D'Hollander, M. Moriera, F. van de Werf. Merck & Company: C. Arena, M. Bremer, C. Cavalente, C. Constantin, P. DiBattiste, J. Lappe, S. Lee, L. Resnansky, S. Snappin. TIMI Study Group: E.M. Antman, E. Braunwald, J.A. de Lemos, C.M. Gibson, J. Holub, C. McCabe, R. Pai. Sites (number enrolled): Argentina (20): Sanatorio Mitre, Buenos Aires: A.S. Liprandi; Clinica Bazterrica, Buenos Aires: V. Mauro; Hospital Italiano, Buenos Aires: M. Cohen; Australia (12): St Vincent's Hospital, Sydney, New South Wales: D. Muller; Ashford Community Hospital, Ashford, South Australia: J. Whitford; Flinders Medical Centre, Bedford Park South Australia: P.E. Aylward; Belgium (42): CHU Sart Tilman service de Cardiologie, Liege: V. Legrand; UZ Gasthuisberg Dienst Cardiologie, Leuven: F. Van de Werf; Dienst Cardiologie, Genk: M. Vrolix; Brazil (14): Hospital Sao Paolo, Sao Paolo: A. Carvalho; Hospital Socor, Belo Horizonte: J. Saad; Canada (31): Centre Hopitalier Universitaire de Montreal, Montreal, Quebec: P. Laramee; Hospital Maisonneuve-Rosemont, Montreal, Quebec: C. Constance; Centre Universite Sante l'estrie Fluerimont, Quebec: M. Nguyen; Jewish Community Hospital, Montreal, Quebec: L. Rudski; Chile (9): Hospital Clinico Pintificia Universidad Catolica, Santiago: R. Corbalan; Columbia (30): Clinica Medellin, Calle: R. Botero; Costa Rica (5): Hospital San Juan de Dios, San Juan: A. Brilla; Germany (37): Charite Universitatsklinicum der humbolt Universitat zu Berlin, Berlin: K.J. Osterziel; Universitat Heidelberg, Heidelberg: H. Kucherer; Chefarzt der II Med Abteilung, Munchen: H. Mudra; Med Abteilung III, Trier: K.E. Hauptmann; Medizinische Klinik 1, Aachen: J. Vom Dahl; Klinikum der Universitat Regensburg, Regensburg: H. Schunkert; Arzt fur Innere Medizen-Kardiologie II, Mainz: H.J. Rupprecht; The Netherlands (24): Leyenburg Hospital, Den Haag: R.M. Robles de Medina; R&D Cardiologie, Eindhoven: R. Michels; Israel (11): Heart Institute, Zerifin: Z. Vered; Italy (7): Ospedale S. Maria delle Croci, Ravenna: A. Maresta; Ospedali Riuniti de Bergamo, Bergamo: G. Guagliumi; Mexico (9): Hospital 1 de Octubre ISSSTE, Salinas: M. Mendiolea; New Zealand (15): Christ Church Hospital, Hamilton: H. Ikram, Waikito Hospital, Hamilton: G. Devlin; Green Lane Hospital, Auckland: H.D. White; Spain (18): Hospital Clinico, Madrid: J. Ferrero-Zorita; Hospital Clinic 1 Provincial, Barcelona: G.S. Romero; Hospital Valle de Hebron, Barcelona: J. Figueras-Bellot; Switzerland (14): Cardio Centra Ticino, Lugano: T. Moccetti; United Kingdom (36): Royal Devon and Exeter Hospital, Exeter, Devon: D. Smith; Blackpool Victoria Hospital, Lancashire: M. Brack; Hairmyers Hospital, Glasgow: K. Oldroyd; Royal Victoria Hospital, Belfast: J. Adgey; United States (75): Good Samaritan Hospital, Dayton, Ohio: A. Abdul-Karim; Columbus Hospital, Columbus, Ohio: P. Amsterdam; University of Texas at Houston Health Science Center: H.V. Anderson; University of Michigan Health Systems, Ann Arbor: E.R. Bates; Washington Adventist Hospital, Takoma Park, Md: D. Brill; Bergan Mercy Medical Center, Omaha: S. Carollo; Sacred Heart Hospital, The Heart Care Grour, Allentown, Pa: W. Combs; Harborview Medical Center, Seattle: M. Corson; Emory University Hospital, Atlanta: J. Douglas; University of Wisconsin Hospitals & Clinics, Madison: D. Ende; University of Massachusetts Memorial Medical Center, Worcester: M. Furman; Iowa Heart Center, Des Moines: M. Ghali; LSU Health Sciences Center, Shreveport: H. Hanley; University of Maryland School of Medicine, Baltimore: W. Herzog: Mercer Bucks Cardiology, Yardley, Pa: G. Heyrich; Heart and Vascular Center of Florida, Port Charlotte: V. Howard; Florida Cardiovascular Research Rothman Center, Atlantis: J. Kieval; Metropolitan Cardiology Consultants, Coon Rapids, Minn: M. Kraemer; Ben Taub General Hospital, Houston: N. Lakkis, South Orange County Cardiovascular Associates, Laguna Hills, Calif: D. LaMont; Latter-Day Saints Hospital, InterMountain Healthcare, Salt Lake City, Utah: J.B. Muhlestein; The Greater Ft. Lauderdale Heart Group Research: A. Niederman; Alabama Cardiovascular Specialists, Alabaster: T. Paul, Jr; Scripps Mercy Hospital, San Diego: P. Phillips; Austin Cardiovascular Associates, Austin, Tex: M. Pirwitz; Oklahoma Foundation for Cardiovascular Research, Oklahoma City: D. Schmidt, J. Williams; St Petersburg-Suncoast Medical Group, St Petersburg, Fla: V. Singh; Winthrop University Hospital, Mineola, NY: R. Steingart; Cardiology of Oklahoma, Tulsa: W.W. Stoever. ",
year = "2005",
month = jul,
doi = "10.1016/j.ahj.2005.01.007",
language = "English (US)",
volume = "150",
pages = "79--88",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "1",
}