Copyright © 2003 by the European Society of Cardiology.
Regular Articles
ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction
a University of Alberta, Edmonton, Canada
b Duke Clinical Research Institute, Durham, NC, USA
c University of Toronto, Ontario, Canada
d University Hospital Gasthuisberg, Leuven, Belgium
e University Hospital, Uppsala, Sweden
* Corresponding author. Paul W. Armstrong, MD, 2–51 Medical Sciences Building, University of Alberta, Edmonton, Alberta, Canada T6G 2H7. Tel.: +1-780-492-0951; fax: +1-780-492-9486
E-mail address: paul.armstrong{at}ualberta.ca
Received 6 February 2003; revised 9 May 2003; accepted 4 June 2003 This paper was guest edited by Prof. Peter L. Thompson, University of Western Australia, Perth, Australia
Aims ASSENT 3 (Assessment of the Safety and Efficacy of a New Thrombolytic) demonstrated that the bolus fibrinolytic tenecteplase (TNK), combined with enoxaparin (ENOX) or abciximab (ABCX), substantially reduced ischemic complications of acute myocardial infarction as compared with unfractionated heparin (UH). We compared ST resolution in each of the three treatment regimens in order to evaluate the speed, extent and stability of ST segment resolution and its relationship to the primary composite endpoint(s) of the trial.
Methods and results We evaluated ST segment shift and its subsequent resolution i.e. complete (
70%), partial (<70–30%) and no resolution (<30%) in 4,304 patients 60 and 180min after treatment. Sixty minutes after therapy there was a trend for both half-dose TNK/ABCX and TNK/UH to have more frequent complete ST resolution (P=0.072) than TNK/ENOX. Pair-wise comparison at 60min revealed that patients receiving TNK/ABCX had significantly more complete ST resolution than TNK/ENOX (P=0.026). Further ST resolution had occurred 180min after treatment: complete ST resolution was greater with TNK/ABCX (59.2%) than the TNK/heparin (50.8%) and TNK/enoxaparin (50.8%) (P<0.001). In the TNK/ENOX group achieving complete ST resolution by 180min, in-hospital reinfarction was 1.9% vs 4.2% for TNK/UH (P=0.015) representing a 2.3% absolute and 55% relative reduction in reinfarction. Thirty day and one year mortality was greatest amongst those patients with <30% ST segment resolution in the TNK/ABCX group.
Conclusions More rapid and complete ST resolution occurs with half-dose TNK/ABCX whereas less reinfarction occurs amongst those patients with 70% ST resolution receiving either TNK/ABCX or TNK/ENOX. These data highlight two potentially complementary mechanisms of clinical benefit associated with different pharmacologic regimens in acute myocardial infarction, i.e. more rapid versus more stable coronary patency.
Key Words: Acute myocardial infarction • Fibrinolysis • ST segment resolution
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