RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR AND HEPARIN IN ACUTE ANGINA AT REST

Because acute myocardial infarction (AMI) and unstable angina have a c ommon pathogenesis, early thrombolytic treatment, proven to be highly beneficial in patients with AMI, may also be suitable for treating pat ients with severe unstable angina. A randomized, single-blind, multice nter, prospective, pilot study was conducted to determine whether earl y treatment with recombinant tissue type plasminogen activator (rt-PA) followed by a 3-day continuous heparin infusion and aspirin could red uce the 1-month incidence of unfavorable outcome (cardiovascular death , AMI, or recurrent angina at rest) in patients with acute angina at r est associated with ischemic electrocardiographic changes. Of the 60 p atients enrolled in the trial, 30 were randomly assigned to receive rt -PA plus heparin and aspirin (rt-PA group) and 30 received heparin and aspirin alone (heparin group). An unfavorable outcome occurred in 7 ( 23.3%) of the 30 patients treated with rt-PA and in 13 (43.3%) of the 30 patients treated with heparin (odds ratio, 0.39; 95% Cl, 0.13-1.2). One (3.3%) patient in the rt-PA group and five (16.6%) in the heparin group (16.6%) died or suffered a non-fatal AMI (odds ratio, 0.17; 95% Cl, 0.02-1.6). Four patients died, all in the heparin group. The resu lts of this study suggest that early treatment with rt-PA can improve the clinical outcome of unstable angina in a specific subgroup of pati ents with acute angina at rest.