Thrombolysis with recombinant human tissue-type plasminogen activator during instability in coronary artery disease: Effect on myocardial ischemia and need for coronary revascularization

Two hundred five men, 40 to 70 years of age, admitted to the coronary care unit with unstable coronary artery disease (unstable angina or non-Q wave myocardial infarction), were randomized to double-blind placebo-controlled treatment with an intravenous infusion of recombinant tissue-type plasminogen activator (rTPA), 1 mg/kg body weight (maximum 100 mg) during 4 hours, in addition to aspirin, heparin, and β-blockade. No severe complications occurred. Myocardial ischemia, defined as myocardial infarction, incapacitating angina despite medication, or signs of ischemia at the exercise test, was reduced by treatment with rTPA compared with placebo both at discharge, 53% compared with 70% ( p = 0.02), and at 1 month, 61% compared with 80% ( p = 0.005). Signs of myocardial ischemia during the exercise test were reduced at discharge 51.0% compared with 68% ( p = 0.03) and at 1 month 48% compared with 62% ( p = 0.09). Coronary angiography after 1 month showed no difference in major coronary lesions between the groups, nor was there any reduction in the number of performed coronary revascularization procedures. In conclusion, treatment with rTPA in unstable coronary artery disease in men reduced myocardial ischemia but did not significantly reduced the need for revascularization in long-term follow-up.