RANDOMIZED CORONARY PATENCY TRIAL OF DOUBLE-BOLUS RECOMBINANT STAPHYLOKINASE VERSUS FRONT-LOADED ALTEPLASE IN ACUTE MYOCARDIAL-INFARCTION

One hundred two patients with evolving myocardial infarction of 6 hour s' duration were given aspirin and intravenous heparin and randomly al located to intravenous front-loaded, weight-adjusted rTPA administrati on over a 90-minute period (52 patients) or to two 15 mg doses of reco mbinant staphylokinase, 30 minutes apart (50 patients). Thrombolysis i n Myocardial Infarction (TIMI) perfusion grade 3 at 90 minutes was ach ieved in 68% (95% confidence interval, 55% to 81%) of patients treated with staphylokinase versus 57% (95% confidence interval, 43% to 72%) of patients treated with rTPA (p = not significant). Double-bolus stop hylokinase was significantly more fibrin-specific than accelerated rTP A with residual fibrinogen at 90 minutes of 105% +/- 4.1% and 68% +/- 75%, respectively (p < 0.0001). Thirteen patients in each study group underwent angioplasty of the culprit coronary artery within the first 24 hours because of suboptimal recanalization (TIMI <3). In the patien ts without prior coronary intervention, TIMI 3 at 24 hours was 100% af ter staphylokinase administration (n = 35) versus 79% after rTPA (n = 34) (p = 0.005). The distribution of inhospital events did not signifi cantly differ between both groups. One patient receiving rTPA died in the hospital from ischemic stroke. Staphylokinase administration did n ot induce allergic reactions, but significant staphylokinase-neutraliz ing activity (>5 mu g/ml) and specific anti-staphylokinase IgG develop ed in 73% of patients after 2 weeks. Thus two 75 mg doses of staphylok inase induce early, complete, and sustained coronary artery patency at least as frequently as accelerated rTPA without associated fibrinogen degradation but with subsequent induction of circulating neutralizing antibodies.