Copyright © 1993 by the European Society of Cardiology.
© 1993 The Europen Society of Cardiology
The effect of taprostene in patients with acute myocardial infarction treated with thrombolytic therapy: results of the START**study
*Department of Cardiology, Academic Hospital, Maastricht, University of Limburg Maastricht, The Netherlands
Department of Cardiology, Medizinische Universitätsklinik Mainz, Germany
Department of Cardiology, Catharina Hospital Eindhoven, The Netherlands
Department of Cardiology, Medizinische Fakultät der RWTH Aachen, Germany
||Department of Statistics, Medizinische Fakultät Ruhr Universität Bochum, Germany
¶Grünenthal GMBH Aachen, Germany
Received 15 December 1992; .
Correspondence Frits W. Bär MD, Department of Cardiology, Academic Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
Abstract
Taprostene is a prostacyclin analogue that inhibits platelet aggregation and thus might be a useful adjuvant to thrombolytic agents in acute myocardial infarction.
In a placebo-controlled dose rising study, taprostene or placebo was intravenously infused in 80 patients treated with the thrombolytic agent saruplase (rscu-PA) for acute myocardial infarction. Three doses of taprostene were used: 6.25; 12.5; or 25.0 ng.kg–1.min–1. Taprostene or placebo was infused for 48 h, followed by a 24 h tapering period. All 80 patients had short symptom-to-treatment delay and marked ST segment elevation.
Patency at 90 min was documented in 58/78 patients (two patients had no angiography). Success rate varied from 67–82% in the four treatment arms (P=0.33). Patency after rescue PTCA was seen in 10 out of 13 patients. Of the 58 patients having a patent artery at 90 min, none of the 43 taprostene patients and one of the 15 placebo patients had a reoccluded artery at the second angiography at 32–48 h (5/58 patients had no recatheterization). Conversely, of nine patients who had successful rescue PTCA, three of four placebo patients had a re-occluded artery at the second angiography compared to one of five taprostene patients (one placebo patient had no recatheterization) (P= 0.33). Safety evaluation revealed no major difference between the placebo plus saruplase and the taprostene plus saruplase groups.
Taprostene was well tolerated up to 25 ng.kg–1 .min–1. Although taprostene did not affect 90 min patency, there was a trend to better maintenance of patency after rescue PTCA.
Key Words: Prostacyclin • saruplase • patency