Thrombolysis with conventional
thrombolytic agents followed by
percutaneous coronary intervention (PCI) had no impact on the treatment of acute
myocardial infarction (AMI). However, the development of mutant type
plasminogen activator (mt-PA) has prompted us to reassess the combination of thrombolysis and PCI.
Monteplase (Eisai, Co. Ltd., Tokyo, Japan) is a newly developed mt-PA that can be administrated as a single intravenous bolus injection. We initiated a clinical trial [Combining
Monteplase with Angioplasty (
COMA)] to evaluate the effectiveness of
monteplase followed by PCI. The AMI patients were randomly assigned to receive PCI following pretreatment with a single bolus
intravenous injection of
monteplase or direct PCI without
monteplase. The initial coronary angiography prior to PCI showed that 36.2% of patients in the
monteplase group achieved Thrombolysis in
Myocardial Infarction (TIMI) 3 flow in the
infarct-related artery, compared with in only 7.9% of patients in the direct PCI group (P < 0.0001). During 24 months following PCI, major
cardiac events occurred in 27.7% of patients in the
monteplase + PCI group, and in 46.7% of patients in the direct PCI group without
monteplase (P < 0.05). Thus, the ideal strategy for the treatment of AMI is the administration of
monteplase upon arrival at a community hospital with a prompt transfer to a tertiary center for PCI.