# Laaggedoseerde alteplase bij primaire PCI naar ischemietijd

*geplaatst 2020-03-31 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2020.01.041 · https://hartvaat.nl/2020/03/31/laaggedoseerde-alteplase-bij-primaire-pci-naar-ischemietijd/*

T-TIME subanalyse naar het effect van laaggedoseerde intracoronaire alteplase naar ischemieduur bij STEMI.

## English: Low-Dose Alteplase During Primary Percutaneous Coronary Intervention According to Ischemic Time.

This T-TIME subanalysis evaluated intracoronary alteplase efficacy by ischemia time in STEMI, testing whether patients with longer ischemia duration derive more benefit from clot-dissolving adjunctive therapy.

## Abstract (original, from the publication)

BACKGROUND: Microvascular obstruction affects one-half of patients with ST-segment elevation myocardial infarction and confers an adverse prognosis. OBJECTIVES: This 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. METHODS: This 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). RESULTS: Overall, 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). CONCLUSION: In 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).

Auteurs: Peter J McCartney, Annette M Maznyczka, Hany Eteiba, Margaret McEntegart, Keith G Oldroyd, John P Greenwood, Neil Maredia, Matthias Schmitt, Gerry P McCann, Timothy Fairbairn, Elisa McAlindon, Campbell Tait, Paul Welsh, Naveed Sattar, Vanessa Orchard, David Corcoran, Thomas J Ford, Aleksandra Radjenovic, Ian Ford, Alex McConnachie, Colin Berry

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2020.01.041. Bijgewerkt 2026-07-03T13:27:39Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.