Recovery of left ventricular function after acute myocardial infarction: efficacy of domiciliary thrombolysis in the Grampian Region Early Anistreplase Trial.

Abstract

BACKGROUND:

The objective was to compare the effect of thrombolytic therapy given either at home or in hospital on the recovery of left ventricular function after acute myocardial infarction.

METHODS:

In a randomized double-blind trial, 311 patients with suspected acute myocardial infarction were given 30 units anistreplase intravenously either at home, or later, in hospital. The median time-saving made with domiciliary thrombolysis was 130 min. All patients were admitted to hospital where left ventricular stroke distance was measured daily using a simple bedside ultrasound technique, and expressed as a percentage of the age-predicted normal value. The last recorded inpatient stroke distance measurement was used to assess residual left ventricular function after recovery from myocardial infarction.

RESULTS:

The mean stroke distance in patients with confirmed myocardial infarction was 74% on the day of admission, rising to 83% on the last inpatient day; it did not change between discharge and 3 months after admission. For 180 patients assigned randomly to treatment within 2 h of the onset of symptoms, mean stroke distance was greater by 6.8% in those given active anistreplase at home rather than in hospital (95% confidence interval 1.0 to 12.7%, P = 0.02), but there was no significant difference in stroke distance following home or hospital thrombolysis in 111 patients assigned treatment after that time (difference -2.0%, 95% confidence interval -8.4 to 4.5%, P = 0.54).

CONCLUSIONS:

The efficacy of thrombolytic therapy is enhanced when administered within 2 h of the onset of symptoms.

• Authors: J M Rawles
• Journal: Coronary artery disease (Coron Artery Dis) Vol. 4 Issue 9 Pg. 801-8 (Sep 1993) ISSN: 0954-6928 [Print] England
• PMID: 8287214 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anistreplase

Topics

• Adult
• Aged
• Aged, 80 and over
• Anistreplase (pharmacology, therapeutic use)
• Clinical Protocols
• Cohort Studies
• Double-Blind Method
• Female
• Home Care Services
• Hospitalization
• Humans
• Injections, Intravenous
• Male
• Middle Aged
• Myocardial Infarction (drug therapy, physiopathology)
• Scotland
• Stroke Volume
• Thrombolytic Therapy
• Time Factors
• Treatment Outcome
• Ventricular Function, Left (drug effects, physiology)