Thrombolysis with recombinant human tissue-type plasminogen activator during instability in coronary artery disease: Effect on myocardial ischemia and need for coronary revascularization

1992 ◽  
Vol 124 (6) ◽  
pp. 1419-1426 ◽  
Author(s):  
Jan-Erik Karlsson ◽  
Ulf Berglund ◽  
Anders Bjo¨rkholm ◽  
Jan Ohlsson ◽  
Eva Swahn ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Human Tissue ◽  
Coronary Revascularization ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Artery Disease ◽  
Disease Effect

scholarly journals P327 Concordance between regadenoson stress echocardiography and spect-MIBI (99mTc) in patients with suspected myocardial ischemia

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J C E M Echarte ◽  
P M S Menendez ◽  
I I G Iglesias ◽  
J V M Vara ◽  
J B R Borrego ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Stress Echocardiography ◽  
Coronary Revascularization ◽  
Kappa Index ◽  
A2a Adenosine Receptor ◽  
Adenosine Receptor Agonist ◽  
Risk Stratum ◽  
Artery Disease

Abstract Background Regadenoson is a selective A2A adenosine receptor agonist approved for the detection of myocardial with SPECT-MIBI. To date, few studies have appraised the utility of this drug using transthoracic echocardiography with the same purpose. We designed this prospective study to evaluate the diagnostic agreement between these two techniques used simultaneously to detect myocardial ischemia. We report our first results evaluating the concordance between both techniques. Methods Patients enrolled were referred to our clinic for the evaluation of chest pain. Myocardial perfusion imaging was performed with regadenoson (400 µg ) which was injected before 99mTc-MIBI. Stress and rest sets of images were evaluated for relative uptake of the radiotracer in order to detect and characterize perfusion defects. The echocardiogram was acquired 60-90 seconds after the administration of the drug using a standardized technique. Two independent observers (one cardiologist and one specialist in nuclear medicine) interpreted the images, both unaware of the result of the complementary technique. Results One hundred twenty five patients were included, 69 (55%) of them males. Median age was 73 years (IQR 65-79). One hundred seventeen patients had both studies interpretable. Thirty-nine (32.5%) patients had had a diagnosis of ischemic heart disease before the study (either a myocardial infarction or a coronary revascularization). The median pre-test probability of coronary artery disease in those without a true previous diagnosis was 30.5% (16.0-50.8), being 50% in the intermediate risk (15-85%) and 49% in the low risk stratum (less than 15%). Significant reductions is systolic and diastolic blood pressure were detected with regadenoson [systolic 134 (21) mmHg Vs 131 (23) mmHg, p < 0.001; diastolic: 78 (12) mmHg Vs 73 (13) mmHg, p < 0.001], with a striking increase in heart rate: 67 (13) bpm Vs 91 (17) bpm, p < 0.001. More patients had a SPECT test showing myocardial ischemia (28% Vs 16%; p < 0.001). Agreement between both tests were 84%. The kappa index obtained from this sample was 0.34 (CI95% 0.15-0.53). Segregating those patients without a history of coronary artery disease (n = 81), the positive test rate were 14% for echo and 20% for SPECT-MIBI (p = 0.019). Kappa index was even lower: 0.29 (CI95% 0.02-0.56). Conclusions. SPECT-MIBI provides more positive tests than stress echocardiography when regadenoson is used as the stressor agent. The concordance between tests is low.

CORONARY THROMBOLYSIS IN DOGS WITH A NONGLYCOSYLATED VARIANT OF HUMAN TISSUE-TYPE PLASMINOGEN ACTIVATOR LACKING THE FINGER AND GROWTH FACTOR DOMAINS

1987 ◽  
Author(s):  
P Cambier ◽  
F van de werf ◽  
D collen
Keyword(s):  
Coronary Artery ◽  
Growth Factor ◽  
Plasminogen Activator ◽  
Human Tissue ◽  
Bolus Injection ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Significant Difference ◽  
Plasma Peak

A variant of human tissue-type plasminogen activator (t-PA-AΔFE3X), with deletion of the NH2-terminal fibronectin-like finger (F) and epidermal growth factor (E) domains, and with amino acid substitution of Gin for Asn at all known N-linked glycosylation sites was expressed in Chinese Hamster Ovary Cells and purified to homogeneity. The thrombolytic and pharmacokinetic properties of this variant were studied in a canine model with copper coil induced thrombosis of the left anterior descending coronary artery. Infusion of t PAΔFE3X at a rate of 5 pg/kg/min for 30 min in 3 dogs resulted in a plateau level in plasma of 0.66 ± 0.08 ug/ml and induced recanalization of the coronary artery within 24 ± 4 min (mean ± SEM). Bolus injections over 2 min of 0.15 mg/kg in 3 dogs resulted in peak antigen levels in plasma of 1.6 ± 0.72 μg/ml and caused reperfusion within 14 ± 6 min. Bolus injection of 0.075 mg/kg in 3 dogs gave plasma antigen levels of 0.81 + 0.20 μg/ml and induced lysis in 31 ±15 min. Further reduction of the bolus to 0.038 mg/kg yielded plasma peak levels of 0.43 ± 0.20 μg/ml but did not cause reperfusion within 3 hours. Bolus injection of 0.075 mg/kg of natural t-PA isolated from melanoma cell culture fluid (Mel-t-PA) resulted in plasma peak levels of 0.46 ± 0.09 μg/ml and caused recanalization within 3 hours in only 1 of 4 dogs. None of the injections was associated with systemic fibrinolytic activation and fibrinogen degradation. The disposition of t-PAΔ related antigen from plasma following bolus injection could be described by a sum of two exponential terms with t1/2α: 17 min and t1/2β: 100 min. No significant difference in disposition rates for the different bolus injections were observed. Corresponding values for t1/2α of Mel-t-PA are 3 min.It is concluded that the deletion mutant t-PAΔFE3X has a markedly slower disposition rate from plasma than intact t-PA, which renders it relatively more effective than natural t-PA after bolus injection.

IMPAIRED FIBRINOLYSIS IN CORONARY ARTERY DISEASE (CAD): INFLUENCE OF AGE AND FAMILY HISTORY (FH)

1987 ◽  
Author(s):  
R Francis ◽  
D Kawanishi ◽  
T Baruch ◽  
P Mahrer ◽  
S Rahimtoola ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Genetic Factors ◽  
Age Of Onset ◽  
Solid Phase ◽  
Venous Occlusion ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Older Subjects ◽  
Artery Disease

We assessed fibrinolysis in 99 subjects with CAD documented by angiography. Tissue-type plasminogen activator (tpa) antigen and activity (act) were measured in plasma by ELISA and solid-phase bioimmunoassay, respectively, pre and post venous occlusion (VO) of the arm for 10 minutes. Pre-VO tpa inhibitor (PAI) was assayed by a modification of the method of Juhan-Vague (Thromb Pes 1984). Mean PAI was significantly higher, and mean post-VO tpa act significantly lower, in all CAD subjects than in 28 normals (no CAD by angiography). Mean increase in tpa antigen with VO (releasable tpa) was significantly lower than that of normals only in CAD subjects with age of onset <45. Mean releasable tpa and tpa act post-VO were lower in CAD subjects with age of onset <45 than in older subjects, lower in those with positive than negative FH of CAD in parents or siblings, and lowest in those with both FH and age of onset <45. In contrast, PAI was higher in older subjects. These data suggest that genetic factors may contribute to impaired fibrinolysis in CAD.

scholarly journals Medical treatment of myocardial ischemia in coronary artery disease: effect of drug regime and irregular dosing in the CAPE II trial

2002 ◽  
Vol 40 (5) ◽  
pp. 917-925 ◽  
Author(s):  
John E Deanfield ◽  
Jean-Marie Detry ◽  
Philippe Sellier ◽  
Paul R Lichtlen ◽  
Eric Thaulow ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Medical Treatment ◽  
Artery Disease ◽  
Disease Effect

scholarly journals Randomized Clinical Trial of Surgical vs. Percutaneous vs. Hybrid Revascularization in Multivessel Coronary Artery Disease: Residual Myocardial Ischemia and Clinical Outcomes at One Year—Hybrid coronary REvascularization Versus Stenting or Surgery (HREVS)

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Vladimir Ganyukov ◽  
Nikita Kochergin ◽  
Aleksandr Shilov ◽  
Roman Tarasov ◽  
Jan Skupien ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Trial ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Sick Leave ◽  
Hospital Stay ◽  
Randomized Clinical Trial ◽  
Coronary Revascularization ◽  
Hybrid Coronary Revascularization ◽  
Artery Disease

Aim. Optimal revascularization strategy in multivessel (MV) coronary artery disease (CAD) eligible for percutaneous management (PCI) and surgery remains unresolved. We evaluated, in a randomized clinical trial, residual myocardial ischemia (RI) and clinical outcomes of MV-CAD revascularization using coronary artery bypass grafting (CABG), hybrid coronary revascularization (HCR), or MV-PCI. Methods. Consecutive MV-CAD patients (n = 155) were randomized (1 : 1 : 1) to conventional CABG (LIMA-LAD plus venous grafts) or HCR (MIDCAB LIMA-LAD followed by PCI for remaining vessels) or MV-PCI (everolimus-eluting CoCr stents) under Heart Team agreement on equal technical and clinical feasibility of each strategy. SPECT at 12 months (primary endpoint of RI that the trial was powered for; a measure of revascularization midterm efficacy and an independent predictor of long-term prognosis) preceded routine angiographic control. Results. Data are given, respectively, for the CABG, HCR, and MV-PCI arms. Incomplete revascularization rate was 8.0% vs. 7.7% vs. 5.7% (p=0.71). Hospital stay was 13.8 vs. 13.5 vs. 4.5 days (p<0.001), and sick-leave duration was 23 vs. 16 vs. 8 weeks (p<0.001). At 12 months, RI was 5 (2, 9)% vs. 5 (3, 7)% vs. 6 (3, 10)% (median; Q1, Q3) with noninferiority p values of 0.0006 (HCR vs. CABG) and 0.016 (MV-PCI vs. CABG). Rates of angiographic graft stenosis/occlusion or in-segment restenosis were 20.4% vs. 8.2% vs. 5.9% (p=0.05). Clinical target vessel/graft failure occurred in 12.0% vs. 11.5% vs. 11.3% (p=0.62). Major adverse cardiac and cerebral event (MACCE) rate was similar (12% vs. 13.4% vs. 13.2%; p=0.83). Conclusion. In this first randomized controlled study comparing CABG, HCR, and MV-PCI, residual myocardial ischemia and MACCE were similar at 12 months. There was no midterm indication of any added value of HCR. Hospital stay and sick-leave duration were shortest with MV-PCI. While longer-term follow-up is warranted, these findings may impact patient and physician choices and healthcare resources utilization. This trial is registered with NCT01699048.

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