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A Sacrez - One of the best experts on this subject based on the ideXlab platform.
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invasive reperfusion study ii multicentre european randomized trial of Anistreplase vs streptokinase in acute myocardial infarction
European Heart Journal, 1991Co-Authors: Gerard Pacouret, Bernard Charbonnier, N D Curien, J P Monassier, A Cribier, P Materne, M L Brochier, R Letac, M Hanssen, A SacrezAbstract:IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2–5-min 30 U Anistreplase intravenous injection with a 1 500 000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30–297 min) in the Anistreplase group and 93 min (range: 22–330 min) in the SK group. The early coronary patency rate was significantly higher in the Anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P<0.05. Fifty patients had assessable coronary angiograms at 90 min and 24 h. The 24-h patency rate was 92.3% (24/26) in the Anistreplase group vs 87.5% (21/24) in the SK group. No early reocclusion occurred in the Anistreplase group vs 15.4% (2/13) in the SK group (NS). Fibrinogen fell to 13.2 ±19.8% on Anistreplase vs 9.4 ±10.3% on SK (NS). Bleeding complications occurred in 12% (7/58) of treated patients in the Anistreplase group vs 20.7% (13/58) in the SK group (NS). Two cerebrovascular accidents occurred after thrombolytic treatment with Anistreplase (3.4%) vs one after SK (1.7%) (NS). Thus, Anistreplase is more effective than intravenous SK and easier to administer.
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Invasive reperfusion study II. Multicentre European randomized trial of Anistreplase vs streptokinase in acute myocardial infarction
European heart journal, 1991Co-Authors: Gerard Pacouret, Bernard Charbonnier, N D Curien, J P Monassier, A Cribier, P Materne, R Letac, M Hanssen, A SacrezAbstract:IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2–5-min 30 U Anistreplase intravenous injection with a 1 500 000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30–297 min) in the Anistreplase group and 93 min (range: 22–330 min) in the SK group. The early coronary patency rate was significantly higher in the Anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P
P Materne - One of the best experts on this subject based on the ideXlab platform.
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Thrombolysis in Patients With Unstable Angina Improves the Angiographic But Not the Clinical Outcome - Results of Unasem, a Multicenter, Randomized, Placebo-controlled, Clinical-trial With Anistreplase
Circulation, 1992Co-Authors: Frits W. Bär, J P Monassier, P Materne, Freek W.a. Verheugt, J. Col, P G Geslin, J. Metzger, P. Raynaud, J. Foucault, C. De ZwaanAbstract:Background. The value of thrombolytic therapy in unstable angina is unclear. Methods and Results. To study this problem, 159 patients were studied in a double-blind, placebo-controlled multicenter trial. Patients without a previous myocardial infarction, with a typical history of unstable angina, and ECG abnormalities indicative of ischemia were included. After baseline angiography, study medication (Anistreplase or placebo) was given. Angiography was repeated after 12-28 hours. A significant decrease occurred in diameter stenosis between the first and second angiogram in the Anistreplase group compared with the placebo group (11% versus 3%, p=0.008). This difference was caused by reopening of occluded vessels in the thrombolytic group. However, no beneficial clinical effects of thrombolytic treatment were found. Bleeding complications were significantly higher in patients who received thrombolytic therapy (21 versus seven patients, p=0.001). Conclusions. Thus, angiographic but no clinical improvement after thrombolytic treatment with Anistreplase was found in patients with unstable angina with an excess of bleeding complications. Therefore, thrombolytic treatment cannot be recommended in patients diagnosed as having unstable angina until proven otherwise.
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invasive reperfusion study ii multicentre european randomized trial of Anistreplase vs streptokinase in acute myocardial infarction
European Heart Journal, 1991Co-Authors: Gerard Pacouret, Bernard Charbonnier, N D Curien, J P Monassier, A Cribier, P Materne, M L Brochier, R Letac, M Hanssen, A SacrezAbstract:IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2–5-min 30 U Anistreplase intravenous injection with a 1 500 000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30–297 min) in the Anistreplase group and 93 min (range: 22–330 min) in the SK group. The early coronary patency rate was significantly higher in the Anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P<0.05. Fifty patients had assessable coronary angiograms at 90 min and 24 h. The 24-h patency rate was 92.3% (24/26) in the Anistreplase group vs 87.5% (21/24) in the SK group. No early reocclusion occurred in the Anistreplase group vs 15.4% (2/13) in the SK group (NS). Fibrinogen fell to 13.2 ±19.8% on Anistreplase vs 9.4 ±10.3% on SK (NS). Bleeding complications occurred in 12% (7/58) of treated patients in the Anistreplase group vs 20.7% (13/58) in the SK group (NS). Two cerebrovascular accidents occurred after thrombolytic treatment with Anistreplase (3.4%) vs one after SK (1.7%) (NS). Thus, Anistreplase is more effective than intravenous SK and easier to administer.
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Invasive reperfusion study II. Multicentre European randomized trial of Anistreplase vs streptokinase in acute myocardial infarction
European heart journal, 1991Co-Authors: Gerard Pacouret, Bernard Charbonnier, N D Curien, J P Monassier, A Cribier, P Materne, R Letac, M Hanssen, A SacrezAbstract:IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2–5-min 30 U Anistreplase intravenous injection with a 1 500 000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30–297 min) in the Anistreplase group and 93 min (range: 22–330 min) in the SK group. The early coronary patency rate was significantly higher in the Anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P
J P Monassier - One of the best experts on this subject based on the ideXlab platform.
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Thrombolysis in Patients With Unstable Angina Improves the Angiographic But Not the Clinical Outcome - Results of Unasem, a Multicenter, Randomized, Placebo-controlled, Clinical-trial With Anistreplase
Circulation, 1992Co-Authors: Frits W. Bär, J P Monassier, P Materne, Freek W.a. Verheugt, J. Col, P G Geslin, J. Metzger, P. Raynaud, J. Foucault, C. De ZwaanAbstract:Background. The value of thrombolytic therapy in unstable angina is unclear. Methods and Results. To study this problem, 159 patients were studied in a double-blind, placebo-controlled multicenter trial. Patients without a previous myocardial infarction, with a typical history of unstable angina, and ECG abnormalities indicative of ischemia were included. After baseline angiography, study medication (Anistreplase or placebo) was given. Angiography was repeated after 12-28 hours. A significant decrease occurred in diameter stenosis between the first and second angiogram in the Anistreplase group compared with the placebo group (11% versus 3%, p=0.008). This difference was caused by reopening of occluded vessels in the thrombolytic group. However, no beneficial clinical effects of thrombolytic treatment were found. Bleeding complications were significantly higher in patients who received thrombolytic therapy (21 versus seven patients, p=0.001). Conclusions. Thus, angiographic but no clinical improvement after thrombolytic treatment with Anistreplase was found in patients with unstable angina with an excess of bleeding complications. Therefore, thrombolytic treatment cannot be recommended in patients diagnosed as having unstable angina until proven otherwise.
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invasive reperfusion study ii multicentre european randomized trial of Anistreplase vs streptokinase in acute myocardial infarction
European Heart Journal, 1991Co-Authors: Gerard Pacouret, Bernard Charbonnier, N D Curien, J P Monassier, A Cribier, P Materne, M L Brochier, R Letac, M Hanssen, A SacrezAbstract:IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2–5-min 30 U Anistreplase intravenous injection with a 1 500 000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30–297 min) in the Anistreplase group and 93 min (range: 22–330 min) in the SK group. The early coronary patency rate was significantly higher in the Anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P<0.05. Fifty patients had assessable coronary angiograms at 90 min and 24 h. The 24-h patency rate was 92.3% (24/26) in the Anistreplase group vs 87.5% (21/24) in the SK group. No early reocclusion occurred in the Anistreplase group vs 15.4% (2/13) in the SK group (NS). Fibrinogen fell to 13.2 ±19.8% on Anistreplase vs 9.4 ±10.3% on SK (NS). Bleeding complications occurred in 12% (7/58) of treated patients in the Anistreplase group vs 20.7% (13/58) in the SK group (NS). Two cerebrovascular accidents occurred after thrombolytic treatment with Anistreplase (3.4%) vs one after SK (1.7%) (NS). Thus, Anistreplase is more effective than intravenous SK and easier to administer.
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Invasive reperfusion study II. Multicentre European randomized trial of Anistreplase vs streptokinase in acute myocardial infarction
European heart journal, 1991Co-Authors: Gerard Pacouret, Bernard Charbonnier, N D Curien, J P Monassier, A Cribier, P Materne, R Letac, M Hanssen, A SacrezAbstract:IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2–5-min 30 U Anistreplase intravenous injection with a 1 500 000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30–297 min) in the Anistreplase group and 93 min (range: 22–330 min) in the SK group. The early coronary patency rate was significantly higher in the Anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P
John Rawles - One of the best experts on this subject based on the ideXlab platform.
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Extended Mortality Benefit of Early Postinfarction Reperfusion
Circulation, 1998Co-Authors: John RawlesAbstract:To the Editor: Ross et al1 (April 28, 1998) report that in the GUSTO-1 angiographic substudy, successful reperfusion produced mortality benefits that were amplified beyond the first 30 days. This extended mortality benefit has been reported previously in the Grampian Region Early Anistreplase Trial (GREAT).2 In this randomized, double-blind, controlled clinical trial, 311 patients with suspected acute myocardial infarction either received Anistreplase prehospital at 105 minutes (median) after symptom onset or in hospital at 240 minutes. At 30 days, there was a trend in favor of prehospital thrombolysis (≈6 lives saved per 100), but this did not reach statistical significance …
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Quantification of the benefit of earlier thrombolytic therapy: five-year results of the Grampian Region Early Anistreplase Trial (GREAT)
Journal of the American College of Cardiology, 1997Co-Authors: John RawlesAbstract:Abstract Objectives. This report presents the 5-year results of the Grampian Region Early Anistreplase Trial (GREAT) and quantifies the benefit of earlier thrombolysis in terms that are generally applicable. Background. Although it is accepted that the earlier thrombolytic therapy is given for acute myocardial infarction the greater the benefit, there are widely differing estimates of the magnitude of the time-related benefit of thrombolysis because of inappropriate trial design and analysis. Methods. In a previously reported randomized trial, Anistreplase (30 U) was given intravenously either before hospital admission or in the hospital, at a median time of 105 and 240 min, respectively, after onset of symptoms. Intention to treat and multivariate analyses of the 5-year results were performed. Results. By 5 years, 41 (25%) of 163 patients had died in the prehospital treatment group compared with 53 (36%) of 148 in the hospital treatment group (log-rank test, p Conclusions. The magnitude of the benefit from earlier thrombolysis is such that giving thrombolytic therapy to patients with acute myocardial infarction should be accorded the same degree of urgency as treatment of cardiac arrest. Policies should be developed for giving thrombolytic therapy on-site if practicable and by the first qualified person to see the patient.
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An economic evaluation of thrombolysis in a remote rural community
BMJ (Clinical research ed.), 1997Co-Authors: Luke Vale, Jonathan Silcock, John RawlesAbstract:Abstract Objectives: To assess the cost effectiveness of community thrombolysis relative to hospital thrombolysis by investigating the extra costs and benefits of a policy of community thrombolysis, then establishing the extra cost per life saved by community thrombolysis. Design: Economic evaluation based on the results of the Grampian region early Anistreplase trial. Setting: 29 rural general practices and one secondary care provider in Grampian, Scotland. Subjects: 311 patients recruited to the Grampian region early Anistreplase trial. Interventions: Intravenous Anistreplase given either by general practitioners or secondary care clinicians. Main outcome measures: Survival at 4 years and costs of administration of thrombolysis. Results: Relative to hospital thrombolysis, community thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of £425 per patient. This gives a marginal cost of life saved at 4 years of £3890 (£1990 to £42 820). Conclusions: The cost per life saved by community thrombolysis is modest compared with, for example, the cost of changing the thrombolytic drug used in hospital from streptokinase to alteplase. Key messages Community thrombolysis leads to increased survival relative to hospital thrombolysis at four years Relative to hospital thrombolysis, community thrombolysis provides this extra benefit at modest extra cost Methods of motivating general practitioners and facilitating routine community thrombolysis need to be ascertained
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Myocardial salvage with early Anistreplase treatment
Clinical cardiology, 1997Co-Authors: John RawlesAbstract:This randomized, double-blind trial in 311 patients with acute myocardial infarction has shown that very early therapy with Anistreplase outside the hospital is not only feasible, but provides a major survival advantage. The difference in the median delay to treatment between the group treated in the hospital and those treated earlier was 2 1/4 h. After 30 months, mortality in the early group was less than half that in the later group, so that every hour of delay beyond 2 h resulted in almost 7 additional deaths per 100 patients treated. This is a greater percentage loss of life than would have resulted from a similar delay in the provision of resuscitation for the prehospital cardiac arrest. Multivariate analysis showed that age, treatment delay, and time of presentation were significant risk factors, with patients presenting at 1 h having more than twice the mortality of those presenting at 4 h; the sicker the patient, the earlier the presentation. By 5 years, prehospital administration of Anistreplase, by saving 2 h, resulted in an additional 57% of a year's survival per patient. This compares favorably with the projected 14% of a year survival per patient reported with TPA versus streptokinase in GUSTO. Prehospital therapy with Anistreplase was highly cost effective when compared with streptokinase given in hospital, and the marginal cost-effectiveness ratio was much lower than that for TPA versus streptokinase derived from GUSTO.
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Magnitude of benefit from earlier thrombolytic treatment in acute myocardial infarction: new evidence from Grampian region early Anistreplase trial (GREAT)
BMJ (Clinical research ed.), 1996Co-Authors: John RawlesAbstract:Abstract Objective: To generalise from the results of the Grampian region early Anistreplase trial (GREAT) and to express the benefit of earlier thrombolysis in terms of lives saved per hour of earlier treatment. Design: Multivariate analysis of a randomised double blind trial. Setting: 29 rural practices in Grampian region and teaching hospitals in Aberdeen. Subjects: 311 patients with suspected acute myocardial infarction and without contraindications to thrombolysis who were seen by their general practitioners within four hours of the start of symptoms. Interventions: Anistreplase 30 units given intravenously, either by general practitioners before hospitalisation or later in hospital. Main outcome measure: Death within 30 months of entry into trial. Results: Death within 30 months was positively related to age (P Conclusions: The magnitude of the benefit from earlier thrombolysis is such that giving thrombolytic treatment to patients with acute myocardial infarction should be accorded the same degree of urgency as the treatment of cardiac arrest. Key messages Key messages However, studies comparing treatment in the community with later treatment in hospital showed that earlier treatment did not significantly reduce mortality in the following month Continued follow up of Grampian region early Anistreplase trial showed that mortality benefit of prehospital thrombolysis trebled between 30 days and 30 months after entry into trial Patients who sought medical help quickly after start of symptoms had more severe infarction, and thus a higher mortality risk, than those seeking help later, which can mask greater efficacy of earlier thrombolysis Giving thrombolytic treatment at the first opportunity should be considered as urgent as treatment of cardiac arrest
Gerard Pacouret - One of the best experts on this subject based on the ideXlab platform.
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invasive reperfusion study ii multicentre european randomized trial of Anistreplase vs streptokinase in acute myocardial infarction
European Heart Journal, 1991Co-Authors: Gerard Pacouret, Bernard Charbonnier, N D Curien, J P Monassier, A Cribier, P Materne, M L Brochier, R Letac, M Hanssen, A SacrezAbstract:IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2–5-min 30 U Anistreplase intravenous injection with a 1 500 000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30–297 min) in the Anistreplase group and 93 min (range: 22–330 min) in the SK group. The early coronary patency rate was significantly higher in the Anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P<0.05. Fifty patients had assessable coronary angiograms at 90 min and 24 h. The 24-h patency rate was 92.3% (24/26) in the Anistreplase group vs 87.5% (21/24) in the SK group. No early reocclusion occurred in the Anistreplase group vs 15.4% (2/13) in the SK group (NS). Fibrinogen fell to 13.2 ±19.8% on Anistreplase vs 9.4 ±10.3% on SK (NS). Bleeding complications occurred in 12% (7/58) of treated patients in the Anistreplase group vs 20.7% (13/58) in the SK group (NS). Two cerebrovascular accidents occurred after thrombolytic treatment with Anistreplase (3.4%) vs one after SK (1.7%) (NS). Thus, Anistreplase is more effective than intravenous SK and easier to administer.
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Invasive reperfusion study II. Multicentre European randomized trial of Anistreplase vs streptokinase in acute myocardial infarction
European heart journal, 1991Co-Authors: Gerard Pacouret, Bernard Charbonnier, N D Curien, J P Monassier, A Cribier, P Materne, R Letac, M Hanssen, A SacrezAbstract:IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2–5-min 30 U Anistreplase intravenous injection with a 1 500 000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30–297 min) in the Anistreplase group and 93 min (range: 22–330 min) in the SK group. The early coronary patency rate was significantly higher in the Anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P
