Low-dose tissue plasminogen activator followed by planned rescue angioplasty reduces time to reperfusion for acute myocardial infarction treated at community hospitals

The time from admission to reperfusion in patients with acute myocardial in farction (AMI) was compared according to the type of hospital and treatment strategy. A total of 164 patients with a first AMI within 12 h of onset we re enrolled at one tertiary emergency center (TEC) and 6 community hospital s (CHs). The subjects were randomly assigned to receive either primary perc utaneous transluminal coronary angioplasty (PTCA) (TEC-primary PTCA and CHs -primary PTCA groups) or 800,000 units of intravenous monteplase, half the standard dose of a mutant tissue plasminogen activator (t-PA), followed by rescue PTCA if the Thrombolysis in Myocardial Infarction (TIMI) flow grade was 2 or less (TEC-monteplase and CHs-monteplase groups) on the first coron ary angiogram. Sixty minutes after admission, TIMI flow grade 3 rates of th e study groups were as follows, in descending order: TEC-monteplase group, CHs-monteplase group, TEC-primary PTCA group, and CHs-primary PTCA group (5 6%, 41%, 36%, and 8%, respectively; p <0.01). However, there was no signifi cant difference in the final TIMI flow grade 3 rate among the 4 groups. In the CHs, the peak creatine kinase tended to be lower in the monteplase grou p than in the primary PTCA group. The results suggest that low-dose montepl ase followed by rescue PTCA is an effective strategy for promoting early re perfusion in patients with AMI, especially those who are treated at CHs.