PMID- 14668180
OWN - NLM
STAT- MEDLINE
DCOM- 20040601
LR  - 20101118
IS  - 1401-7431 (Print)
IS  - 1401-7431 (Linking)
VI  - 37
IP  - 6
DP  - 2003 Dec
TI  - Results from clinical trials on ST-elevation myocardial infarction in a historic 
      perspective with some pathophysiological aspects.
PG  - 316-23
AB  - OBJECTIVE: Since the publication of the large trials on streptokinase and aspirin 
      improving mortality related to an acute ST-elevation myocardial infarction 
      (STEMI) there has been numerous studies on improving treatment results with new 
      fibrinolytics, adjuvant heparin therapy and primary percutaneous intervention 
      (PCI). The aim of the present overview is, in a historic perspective, to link 
      some of the pathophysiology of mechanisms related to plaque rupture and following 
      thrombosis to the effects of drug combinations and PCI observed in major clinical 
      trials conducted in patients with STEMI. DESIGN: The overview comprises short 
      analyses of the initial streptokinase trials (GISSI-1 and ISIS-2), the 
      comparisons between streptokinase and tissue plasminogen activator (rt-PA) and 
      the role of adjuvant heparin treatment (GISSI-2, ISIS-3, GUSTO I). Also included 
      is the comparison between the new bolus-teplases and traditional, accelerated 
      infusion of rt-PA (GUSTO III and ASSENT-2) and between unfractionated heparin 
      (UFH) and low molecular weight heparin (LWMH) given in addition to tenecteplase 
      (ASSENT-3). The pathophysiology of the antiplatelet and antithrombin effects is 
      described, in order to elucidate the treatment differences observed in the 
      trials. In addition, the role of primary PCI is discussed in view of the results 
      in a recent meta-analysis of controlled comparisons with fibrinolytic therapy. 
      RESULTS: Based upon these trials it seems that the optimal thrombolytic treatment 
      is a combination of a bolus-teplase (tenecteplae) and LMWH given on top of 
      aspirin. Primary PCI may be the most optimal treatment, provided given early 
      following STEMI (<1 h), but whether PCI is the best alternative for all patients 
      with STEMI is still a matter of debate. CONCLUSION: During the last 15 years the 
      optimal antithrombotic treatment of STEMI has developed from a combination of 
      streptokinase and aspirin to the new bolus-teplases combined with LMWH and 
      aspirin. The use of primary PCI may be a better alternative than fibrinolytic 
      therapy, but such a statement needs confirmation in a large comparison between 
      PCI and a quick infusion of modern fibrinolytic agents.
FAU - Otterstad, Jan Erik
AU  - Otterstad JE
AD  - Division of Cardiology, Vestfold Hospital, Toensberg, Norway. 
      jan.erik.otterstad@siv.no
FAU - Brosstad, Frank
AU  - Brosstad F
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Scand Cardiovasc J
JT  - Scandinavian cardiovascular journal : SCJ
JID - 9708377
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Angioplasty, Balloon, Coronary
MH  - Clinical Trials as Topic
MH  - Electrocardiography
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy/*physiopathology
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Stents
MH  - Thrombolytic Therapy/*methods
MH  - Treatment Outcome
RF  - 32
EDAT- 2003/12/12 05:00
MHDA- 2004/06/02 05:00
CRDT- 2003/12/12 05:00
PHST- 2003/12/12 05:00 [pubmed]
PHST- 2004/06/02 05:00 [medline]
PHST- 2003/12/12 05:00 [entrez]
AID - UUJ71HLBJ4M4U6G0 [pii]
AID - 10.1080/14017430310015875 [doi]
PST - ppublish
SO  - Scand Cardiovasc J. 2003 Dec;37(6):316-23. doi: 10.1080/14017430310015875.