Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction; results of the Thrombolysis in Myocardial Infarction (TIMI) Phase II Trial

Article Abstract:

Heart attacks are sometimes caused by blood clots which block arteries supplying the heart muscle. Plasminogen activator, a thrombolytic substance used to dissolve clots and clear blood vessels, was injected into 3,262 patients having chest pain caused by a heart attack. Two treatment groups were established. The invasive-procedure group (1,636 patients) underwent an arteriography, the administration of radioactive dye to visualize arteries, and if the results warranted, an immediate angioplasty, a method of dilating narrowed blood vessels. The conventional care group (1,626 patients) had no invasive procedures immediately and waited until angioplasty was required. Of the patients in the invasive group, 56.7 percent required an angioplasty with a 93.3 percent success rate. In the conservative group, 13.3 percent of the patients had to have an angioplasty within two weeks of the onset of symptoms. Death rates were comparable, 10.9 percent in the invasive group and 9.7 percent in the conservative group. Brain hemorrhage occurred as a complication of thrombolytic therapy in 26 patients. A subgroup of 1390 patients was given a beta-adrenergic blocking agent, metoprolol, a drug used to treat high blood pressure, immediately and on day six. Immediate administration did not affect mortality but was beneficial in lowering the frequency of a second heart attack while in the hospital. The invasive treatment plan of thrombolytic therapy and angioplasty had no advantage over the conservative measures, either in reducing mortality or recurrent heart attacks. Patients can remain in community hospitals unequipped for invasive procedures and begin thrombolytic therapy without incurring the additional costs of an angioplasty.

Research, United States. National Institutes of Health, Adrenergic beta blockers, Adrenergic beta-antagonists, Arteries, Imaging

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TIMI II and the role of angioplasty in acute myocardial infarction

Article Abstract:

Two groups of patients were given drug treatment with tissue plasminogen activator to dissolve clots responsible for heart attacks. One group, the invasive strategy group, underwent angiography, the use of a radioactive material injected into the heart vessels to visualize vessel narrowing. If possible, angioplasty, a type of surgery used to dilate narrowing vessels, was performed. The second group was managed with a conservative strategy of performing the angiogram and angioplasty only if attacks recurred spontaneously or as a result of exercise. The results of this study indicated that it is not necessary to perform these invasive tests and treatments in patients with recurring episodes. Patients can remain in community hospitals unequipped for angioplasty and reduce the cost of treatments and excessive patient transfer to other facilities. In patients without signs of recurrent attacks, preventative angioplasty is not superior to conservative treatments after thrombolytic (clot- dissolving) therapy. It is suggested that future tests be performed which examine the results of angioplasty without previous thrombolytic treatment compared with conservative strategy outcomes. Evaluation of early angioplasty on totally blocked vessels should also be investigated.

editorial, Streptokinase

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A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction

Article Abstract:

Angioplasty may be more effective than thrombolytic therapy in the treatment of patients with a heart attack. These are both procedures to open clogged arteries, which are the primary cause of heart attacks. Researchers randomly assigned 1,138 patients admitted to a hospital with signs of a heart attack to receive either angioplasty or the thrombolytic drug tissue plasminogen activator (t-PA). Thirty days later, the incidence of death, second heart attack or stroke was lower in the group treated with angioplasty. At six months, however, there was no significant difference in these outcomes between the two groups.

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