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ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction.

Publication ,  Journal Article
Armstrong, PW; Wagner, G; Goodman, SG; Van de Werf, F; Granger, C; Wallentin, L; Fu, Y; ASSENT 3 Investigators,
Published in: Eur Heart J
August 2003

AIMS: ASSENT 3 (Assessment of the Safety and Efficacy of a New Thrombolytic) demonstrated that the bolus fibrinolytic tenecteplase (TNK), combined with enoxaparin (ENOX) or abciximab (ABCX), substantially reduced ischemic complications of acute myocardial infarction as compared with unfractionated heparin (UH). We compared ST resolution in each of the three treatment regimens in order to evaluate the speed, extent and stability of ST segment resolution and its relationship to the primary composite endpoint(s) of the trial. METHODS AND RESULTS: We evaluated ST segment shift and its subsequent resolution i.e. complete (> or =70%), partial (<70-30%) and no resolution (<30%) in 4,304 patients 60 and 180 min after treatment. Sixty minutes after therapy there was a trend for both half-dose TNK/ABCX and TNK/UH to have more frequent complete ST resolution (P=0.072) than TNK/ENOX. Pair-wise comparison at 60 min revealed that patients receiving TNK/ABCX had significantly more complete ST resolution than TNK/ENOX (P=0.026). Further ST resolution had occurred 180 min after treatment: complete ST resolution was greater with TNK/ABCX (59.2%) than the TNK/heparin (50.8%) and TNK/enoxaparin (50.8%) (P<0.001). In the TNK/ENOX group achieving complete ST resolution by 180 min, in-hospital reinfarction was 1.9% vs 4.2% for TNK/UH (P=0.015) representing a 2.3% absolute and 55% relative reduction in reinfarction. Thirty day and one year mortality was greatest amongst those patients with <30% ST segment resolution in the TNK/ABCX group. CONCLUSIONS: More rapid and complete ST resolution occurs with half-dose TNK/ABCX whereas less reinfarction occurs amongst those patients with > or =70% ST resolution receiving either TNK/ABCX or TNK/ENOX. These data highlight two potentially complementary mechanisms of clinical benefit associated with different pharmacologic regimens in acute myocardial infarction, i.e. more rapid versus more stable coronary patency.

Duke Scholars

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

August 2003

Volume

24

Issue

16

Start / End Page

1515 / 1522

Location

England

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Time Factors
  • Thrombolytic Therapy
  • Tenecteplase
  • Regression Analysis
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Middle Aged
  • Male
 

Citation

APA
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ICMJE
MLA
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Armstrong, P. W., Wagner, G., Goodman, S. G., Van de Werf, F., Granger, C., Wallentin, L., … ASSENT 3 Investigators, . (2003). ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction. Eur Heart J, 24(16), 1515–1522. https://doi.org/10.1016/s0195-668x(03)00322-1
Armstrong, Paul W., Galen Wagner, Shaun G. Goodman, Frans Van de Werf, Christopher Granger, Lars Wallentin, Yuling Fu, and Yuling ASSENT 3 Investigators. “ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction.Eur Heart J 24, no. 16 (August 2003): 1515–22. https://doi.org/10.1016/s0195-668x(03)00322-1.
Armstrong PW, Wagner G, Goodman SG, Van de Werf F, Granger C, Wallentin L, et al. ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction. Eur Heart J. 2003 Aug;24(16):1515–22.
Armstrong, Paul W., et al. “ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction.Eur Heart J, vol. 24, no. 16, Aug. 2003, pp. 1515–22. Pubmed, doi:10.1016/s0195-668x(03)00322-1.
Armstrong PW, Wagner G, Goodman SG, Van de Werf F, Granger C, Wallentin L, Fu Y, ASSENT 3 Investigators. ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction. Eur Heart J. 2003 Aug;24(16):1515–1522.
Journal cover image

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

August 2003

Volume

24

Issue

16

Start / End Page

1515 / 1522

Location

England

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Time Factors
  • Thrombolytic Therapy
  • Tenecteplase
  • Regression Analysis
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Middle Aged
  • Male