Trial reportJournal of the American College of Cardiology2020
Low-Dose Alteplase During Primary Percutaneous Coronary Intervention According to Ischemic Time.
Trial report in Journal of the American College of Cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02257294 (A Randomised, Double Blind, Placebo-controlled, Parallel Group Trial of Low-dose Adjunctive alTeplase During prIMary PCI), which is not on this map. Cited by 12 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomised, Double Blind, Placebo-controlled, Parallel Group Trial of Low-dose Adjunctive alTeplase During prIMary PCI
Who cites it
12 citing papers in PubMed, 31 citations in OpenAlex.
- Assessment of Reperfusion Efficacy of Altelyse Versus Actilyse in Patients with Acute Myocardial Infarction: A Phase 3, Randomized, Double-Blinded, Non-inferiority Clinical Trial.Clinical drug investigation · 2025Trial
- Long-term outcome of patients with ST-segment elevation myocardial infarction treated with low-dose intracoronary thrombolysis during primary percutaneous coronary intervention: the 5-year results of the DISSOLUTION Trial.Journal of thrombosis and thrombolysis · 2021Trial
- Dissolving porcine and human microthrombi by short exposure to microdoses of alteplase in an in vitro model of microvascular obstruction.Scientific reports · 2025Article
- Pathophysiology and Treatment of the No-Reflow Phenomenon in ST-Segment Elevation Myocardial Infarction: Focus on Low-Dose Fibrinolysis during Primary Percutaneous Intervention.Reviews in cardiovascular medicine · 2023Review
- Microvascular Obstruction in Acute Myocardial Infarction, a Potential Therapeutic Target.Journal of clinical medicine · 2023Review
- Prospects for Precision Medicine in Acute Myocardial Infarction: Patient-Level Insights into Myocardial Injury and Repair.Journal of clinical medicine · 2023Review
- Coronary Microcirculation: The Next Frontier in the Management of STEMI.Journal of clinical medicine · 2023Review
- Low-dose fibrinolysis during primary percutaneous intervention for preventing no-reflow: stepping back to move forward?EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2022Article
- 2021 Update for the Diagnosis and Management of Acute Coronary Syndromes for the Perioperative Clinician.Journal of cardiothoracic and vascular anesthesia · 2022Review
- Impact of intracoronary reteplase during primary percutaneous coronary intervention on infarct size in large anterior myocardial infarction: rationale and design of the RECOVER II trial.Cardiovascular diagnosis and therapy · 2022Article
- Effects of intracoronary antithrombotics on ventricular function: A comparison of tenecteplase versus abciximab during primary percutaneous intervention in myocardial infarction.Cardiology journal · 2021Article
- Recombinant Tissue Plasminogen Activator (r-tPA) Induces In-Vitro Human Neutrophil Migration via Low Density Lipoprotein Receptor-Related Protein 1 (LRP-1).International journal of molecular sciences · 2020Article
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Authors and funding
22 authors at 11 institutions in 2 countries.
Funding
Abstract
backgroundMicrovascular obstruction affects one-half of patients with ST-segment elevation myocardial infarction and confers an adverse prognosis.
objectivesThis study aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intracoronary alteplase infused early after coronary reperfusion associates with ischemic time.
methodsThis study was conducted in a prospective, multicenter, parallel group, 1:1:1 randomized, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified subgroup of interest. Between March 17, 2016, and December 21, 2017, 440 patients, presenting with ST-segment elevation myocardial infarction within 6 h of symptom onset (<2 h, n = 107; ≥2 h but <4 h, n = 235; ≥4 h to 6 h, n = 98), were enrolled at 11 U.K. hospitals. Participants were randomly assigned to treatment with placebo (n = 151), alteplase 10 mg (n = 144), or alteplase 20 mg (n = 145). The primary outcome was the amount of microvascular obstruction (MVO) (percentage of left ventricular mass) quantified by cardiac magnetic resonance imaging at 2 to 7 days (available for 396 of 440).
resultsOverall, there was no association between alteplase dose and the extent of MVO (p for trend = 0.128). However, in patients with an ischemic time ≥4 to 6 h, alteplase increased the mean extent of MVO compared with placebo: 1.14% (placebo) versus 3.11% (10 mg) versus 5.20% (20 mg); p = 0.009 for the trend. The interaction between ischemic time and alteplase dose was statistically significant (p = 0.018).
conclusionIn patients presenting with ST-segment elevation myocardial infarction and an ischemic time ≥4 to 6 h, adjunctive treatment with low-dose intracoronary alteplase during primary percutaneous coronary intervention was associated with increased MVO. Intracoronary alteplase may be harmful for this subgroup. (A Trial of Low-Dose Adjunctive Alteplase During Primary PCI [T-TIME]; NCT02257294).
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