More Rapid, Complete, and Stable Coronary Thrombolysis With Bolus Administration of Reteplase Compared With Alteplase Infusion in Acute Myocardial Infarction

• DOI: 10.1161/01.cir.91.11.2725
• Publication Date: 2012-06-12T00:34:42Z
• Authors: Richard W. Smalling; Christoph Bode; John Kalbfleisch; Semi Sen; Peter Limbourg; Florian Forycki; Gabriel Habib; Robert Feldman; Stefan Hohnloser; Allen Seals
• Keywords: Reteplase; TIMI; Bolus (digestion); T-plasminogen activator

Background Early restoration and maintenance of normal (TIMI 3) blood flow during acute myocardial infarction is critical for optimal preservation left ventricular function survival. Recombinant plasminogen activator (r-PA, reteplase) a nonglycosylated deletion mutant wild-type tissue-type (TPA) that has been shown to achieve more rapid complete thrombolysis compared with other activators in animal models. Methods Results The RAPID Trial was designed test the hypothesis bolus administration one or dosage regimens r-PA superior standard-dose alteplase achieving infarct-related artery patency 90 minutes after initiation treatment. Six hundred six patients were randomized four treatment arms: (1) TPA 100 mg IV over 3 hours, (2) as 15-MU single bolus, (3) 10-MU followed by 5 MU 30 later, (4) 10 later. Coronary arteriography performed at 30, 60, hospital discharge. 10+10-MU group achieved better 90-minute 5- 14-day TIMI (63% [CI, 55% 71%] versus 49% [41% 57%], P =.019, 88% [82% 94%] 71% [63% 79%], <.001, respectively) than group. 60 equivalent (51 49%). Global ejection fraction regional wall motion those discharge (53±1.3% 49±1.3%, =.034; −2.19±0.12 −2.61±0.13 SD per chord, =.02, respectively). 10+5-MU results similar inferior Bleeding complications between groups. Conclusions given double 10+10 achieves rapid, complete, sustained TPA, without an apparent increased risk complications. This associated improved global