Abstract 1760: Facilitated Percutaneous Coronary Intervention with Minimal Dose Thrombolytic Agent in Patients with ST-Segment Elevation Acute Myocardial Infarction (ATHENS PCI): A Multicenter Randomized Trial
Background: Facilitated percutaneous coronary intervention (PCI) preceded by administration of IIb/IIIa inhibitors or/and full-dose thrombolytic is associated with no benefit (IIb/IIIa inhibitors) or more major adverse events (thrombolytic) than PCI alone. We postulated that minimal dose thrombolytic therapy might lead in early patency of the infract related artery (IRA) without the adverse events of full thrombolytic treatment.
Aim: The aim of the present open-label randomized study was to assess the efficacy of minimal dose tenecteplase preceding PCI to achieve TIMI grade 2 or 3 blood flow in the IRA in patients with STEMI scheduled to undergo primary PCI with a minimal anticipated delay of 30min.
Methods: Patients with STEMI of less than 6 h duration were randomized to PCI preceded by administration of 10 mg tenecteplase (minimal thrombolysis group, n = 80) or standard PCI (control group, n = 79). All patients received aspirin and a bolus of unfractionated heparin (70IU/kg, no upper limit dose) at randomization. Both treatment groups received IIb/IIIa inhibitors at cath lab and for at least 20hours after PCI.
Results: The median door to balloon time was 138 min in minimal thrombolysis group versus 130 min in control group. Patency on cath lab arrival was 65.7% in minimal thrombolysis group (14.3% TIMI-2, 51.4% TIMI-3), versus 36.6% in control group (9.9% TIMI-2, 26.8 % TIMI-3) (p = 0.001). During hospital stay 4 patients (5%) died in minimal thrombolysis group versus 5 patients (6.3%) in control, p = 0.743. No strokes were observed in patients assigned to any treatment group.
Conclusion: Facilitated PCI with minimal dose thrombolytic agent is associated with high rate of IRA patency pre PCI, in patients with STEMI.