Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction

被引:67
作者
Simoons, ML
Krzemiñska-Pakula, M
Alonso, A
Goodman, SG
Kali, A
Loos, U
Gosset, F
Louer, V
Bigonzi, F
机构
[1] Erasmus Univ, Med Ctr, Thoraxctr, NL-3015 GD Rotterdam, Netherlands
[2] Wojewodski Szpital, Kniaziewicza, Poland
[3] Puerta Hierro, Madrid, Spain
[4] Univ Toronto, St Michaels Hosp, Div Cardiol, Toronto, ON M5B 1W8, Canada
[5] Natl Inst Cardiol, Budapest, Hungary
[6] Knappschafts Krankenhaus, Recklinghausen, Germany
[7] Aventis Pharma, Paris, France
关键词
myocardial infarction; streptokinase; low-molecular-weight heparin; enoxaparin;
D O I
10.1053/euhj.2001.3083
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims To establish whether the addition of enoxaparin (a low-molecular-weight heparin) to streptokinase therapy improves early and sustained coronary patency and clinical outcome in patients with evolving myocardial infarction. Methods and Results A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30 mg) and subcutaneous injections (1 mg . kg(-1), twice daily) of enoxaparin (n = 253), or placebo (n = 243) for 3-8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90 min and 180 min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180 min was observed in 36%, 44% and 19% in the enoxaparin group vs 25%, 44% and 31% in the placebo group, respectively (P = 0.004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70% vs 58%, P = 0.01). Combined TIMI-2 and -3 flow was also improved (88% vs 72%, P = 0.001), as was TIMI frame count (P = 0.003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13% vs 21%, P = 0.03). Conclusion Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5-10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion. (C) 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
引用
收藏
页码:1282 / 1290
页数:9
相关论文
共 37 条
  • [1] [Anonymous], 1990, LANCET, V336, P65
  • [2] Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction - Results of the thrombolysis in myocardial infarction (TIMI) 11B trial
    Antman, EM
    McCabe, CH
    Gurfinkel, EP
    Turpie, AGG
    Bernink, PJLM
    Salein, D
    de Luna, AB
    Fox, K
    Lablanche, JM
    Radley, D
    Premmereur, J
    Braunwald, E
    [J]. CIRCULATION, 1999, 100 (15) : 1593 - 1601
  • [3] *ASPECT 2, 2000, EUR C CARD AMST
  • [4] Baardman T, 1996, EUR HEART J, V17, P237
  • [5] Low molecular weight heparin versus unfractionated heparin following thrombolysis in myocardial infarction
    Baird, SH
    Mc Bride, SJ
    Trouton, TG
    Wilson, C
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 31 (02) : 191A - 191A
  • [6] EFFECT OF HEPARIN ON CORONARY ARTERIAL PATENCY AFTER THROMBOLYSIS WITH TISSUE PLASMINOGEN-ACTIVATOR IN ACUTE MYOCARDIAL-INFARCTION
    BLEICH, SD
    NICHOLS, TC
    SCHUMACHER, RR
    COOKE, DH
    TATE, DA
    TEICHMAN, SL
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1990, 66 (20) : 1412 - 1417
  • [7] HEMORRHAGIC EVENTS DURING THERAPY WITH RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR, HEPARIN, AND ASPIRIN FOR ACUTE MYOCARDIAL-INFARCTION - RESULTS OF THE THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI), PHASE-II TRIAL
    BOVILL, EG
    TERRIN, ML
    STUMP, DC
    BERKE, AD
    FREDERICK, M
    COLLEN, D
    FEIT, F
    GORE, JM
    HILLIS, LD
    LAMBREW, CT
    LEIBOFF, R
    MANN, KG
    MARKIS, JE
    PRATT, CM
    SHARKEY, SW
    SOPKO, G
    TRACY, RP
    CHESEBRO, JH
    [J]. ANNALS OF INTERNAL MEDICINE, 1991, 115 (04) : 256 - 265
  • [8] Brouwer MA, 2000, CIRCULATION, V102, P600
  • [9] A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease
    Cohen, M
    Demers, C
    Gurfinkel, EP
    Turpie, AGG
    Fromell, GJ
    Goodman, S
    Langer, A
    Califf, RM
    Fox, KAA
    Premmereur, J
    Bigonzi, F
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1997, 337 (07) : 447 - 452
  • [10] A synthetic factor-Xa inhibitor (ORG31540/SR9017A) as an adjunct to fibrinolysis in acute myocardial infarction - The PENTALYSE study
    Coussement, PK
    Bassand, JP
    Convens, C
    Vrolix, M
    Boland, J
    Grollier, G
    Michels, R
    Vahanian, A
    Vanderheyden, M
    Rupprecht, HJ
    Van de Werf, F
    [J]. EUROPEAN HEART JOURNAL, 2001, 22 (18) : 1716 - 1724