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A randomized factorial trial of reperfusion strategies and aspirin dosing in acute myocardial infarction. The DUCCS-II Investigators.

Publication ,  Journal Article
O'Connor, CM; Meese, RB; McNulty, S; Lucas, KD; Carney, RJ; LeBoeuf, RM; Maddox, W; Bethea, CF; Shadoff, N; Trahey, TF; Heinsimer, JA ...
Published in: Am J Cardiol
April 15, 1996

The focus of new research efforts to improve the morbidity and mortality associated with acute myocardial infarction (AMI) has turned to adjuvant agents that show promise of improving outcomes following coronary thrombolysis. We enrolled 162 patients with AMI in a randomized trial comparing front-loaded tissue-plasminogen activator (t-PA) plus weight-adjusted heparin with anisoylated plasminogen streptokinase activator complex (APSAC) without heparin as well as standard-dose (325 mg) and low-dose (81 mg) aspirin. The primary end point was an in-hospital morbidity profile; secondary end points were clinical and angiographic potency and hemorrhagic events. Selected sites performed an electrocardiographic substudy to determine the time to 50% ST-segment recovery and the time to steady state. Although the trial was terminated when the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries-I trial showed that t-PA had a significant mortality advantage over streptokinase, important trends were evident. Patients given t-PA and heparin were better anticoagulated (p = 0.001), yet AP-SAC-treated patients had more bleeding complications. The primary end point favored t-PA (25.4% vs 31.3%), and the secondary end points were similar in both groups. In the electrocardiographic substudy, the t-PA group achieved both 50% ST-segment recovery and steady-state recovery sooner than the APSAC group. Patients taking low-dose aspirin had lower in-hospital mortality and less recurrent ischemia but more strokes than the standard-dose aspirin group. Thus, this trial demonstrated trends favoring front-loaded t-PA with weight-adjusted heparin over APSAC without heparin in the treatment of AMI. The use of low-dose aspirin did not appear to impose a loss of protection from adverse events, nor did standard-dose aspirin increase serious bleeding.

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Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

April 15, 1996

Volume

77

Issue

10

Start / End Page

791 / 797

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Platelet Aggregation Inhibitors
  • Plasminogen Activators
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
 

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O’Connor, C. M., Meese, R. B., McNulty, S., Lucas, K. D., Carney, R. J., LeBoeuf, R. M., … Califf, R. M. (1996). A randomized factorial trial of reperfusion strategies and aspirin dosing in acute myocardial infarction. The DUCCS-II Investigators. Am J Cardiol, 77(10), 791–797. https://doi.org/10.1016/s0002-9149(97)89171-0
O’Connor, C. M., R. B. Meese, S. McNulty, K. D. Lucas, R. J. Carney, R. M. LeBoeuf, W. Maddox, et al. “A randomized factorial trial of reperfusion strategies and aspirin dosing in acute myocardial infarction. The DUCCS-II Investigators.Am J Cardiol 77, no. 10 (April 15, 1996): 791–97. https://doi.org/10.1016/s0002-9149(97)89171-0.
O’Connor CM, Meese RB, McNulty S, Lucas KD, Carney RJ, LeBoeuf RM, et al. A randomized factorial trial of reperfusion strategies and aspirin dosing in acute myocardial infarction. The DUCCS-II Investigators. Am J Cardiol. 1996 Apr 15;77(10):791–7.
O’Connor, C. M., et al. “A randomized factorial trial of reperfusion strategies and aspirin dosing in acute myocardial infarction. The DUCCS-II Investigators.Am J Cardiol, vol. 77, no. 10, Apr. 1996, pp. 791–97. Pubmed, doi:10.1016/s0002-9149(97)89171-0.
O’Connor CM, Meese RB, McNulty S, Lucas KD, Carney RJ, LeBoeuf RM, Maddox W, Bethea CF, Shadoff N, Trahey TF, Heinsimer JA, Burks JM, O’Donnell G, Krucoff MW, Califf RM. A randomized factorial trial of reperfusion strategies and aspirin dosing in acute myocardial infarction. The DUCCS-II Investigators. Am J Cardiol. 1996 Apr 15;77(10):791–797.
Journal cover image

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

April 15, 1996

Volume

77

Issue

10

Start / End Page

791 / 797

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Platelet Aggregation Inhibitors
  • Plasminogen Activators
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans