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European Heart Journal 1991 12(2):179-185;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Invasive reperfusion study II. Multicentre European randomized trial of anistreplase vs streptokinase in acute myocardial infarction

G. PACOURET*,, B. CHARBONNIER*, N. D. CURIEN{dagger}, J.P. MONASSIER||, A. CRIBIER, P. MATERNE{ddagger}, MIREILLE L. BROCHIER*, R. LETAC, M. HANSSEN{dagger}, A. SACREZ§ and H. KULBERTUS{ddagger}

*Cardiology Department, University Hospital Trousseau Tours, France
{dagger}Hópital Bichat Paris, France
||Clinique St Joseph Colmar, France
Cardiology Department, University Hospital Rouen, France
{ddagger}Cardiology Department, Hôpital de Baviére Liège, Belgium
§Cardiology Department, University Hospital Strasbourg, France

Received 27 July 1989; revised 5 February 1990; .

Address for correspondence: G. Pacouret, Clinique Cardiologique, CHU Trousseau, 37044 Tours Cedex, France.

Abstract

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.

Key Words: Acute myocardial infarction • thrombolysis • streptokinase • early coronary patency rate • reocclusion • anistreplase


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