A randomized factorial trial of reperfusion strategies and aspirin dosing in acute myocardial infarction

O’Connor, Christopher M.; Meese, Roderick B.; McNulty, Steven E.; Lucas, Kathi D.; Carney, Robert J.; LeBoeuf, Renee M.; Maddox, W. Todd; Bethea, Charles F.; Shadoff, Neal; Trahey, Thomas F.; Heinsimer, James A.; Burks, John M.; O’Donnell, Gerard; Krucoff, Mitchell W.; Califf, Robert M.

doi:10.1016/s0002-9149(97)89171-0

Cited by 23 publications

(10 citation statements)

References 18 publications

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“…16 For example, platelet ␣-granules, in addition to containing PECAM-1, incorporate plasminogen activator inhibitor-1 16 and ␣ 2 -antiplasmin. 17 Re- lease of these proteins theoretically could result in reduced thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

Effect of Thrombolytic Therapy on Platelet Expression and Plasma Concentration of PECAM-1 (CD31) in Patients With Acute Myocardial Infarction

Serebruany

Gurbel

1999

ATVB

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Abstract-Animal studies have shown that the administration of antibodies against platelet/endothelial cell adhesion molecule-1 (PECAM-1) before reperfusion can reduce infarct size. The purpose of the present study was to define the effects of thrombolytic therapy in acute myocardial infarction (AMI) patients on the platelet expression and plasma concentrations of PECAM-1 at prespecified time points after attempted reperfusion. The plasma concentration and platelet expression of PECAM-1 were determined in 23 AMI patients enrolled in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III) trial before thrombolysis and at 3, 6, 12, and 24 hours thereafter and compared with 22 healthy controls. At baseline, PECAM-1 was expressed significantly more on the platelet surface in the AMI patients than in controls (Pϭ0.027) while soluble PECAM-1 plasma levels were almost identical between groups. There were no significant diurnal variations in both plasma and platelet PECAM-1 levels in controls. A significant decrease in platelet PECAM-1 expression was observed 3 hours after thrombolysis (Pϭ0.03) compared with baseline, followed by a significant increase (Pϭ0.004) in fluorescence intensity later at 24 hours after thrombolysis. Conversely, a significant increase in soluble PECAM-1 was observed 3 hours after thrombolysis (Pϭ0.02), followed by a significant decrease later at 24 hours after attempted reperfusion (Pϭ0.03). The expression of platelet-bound PECAM-1 is increased in AMI patients. Discordantly directed changes in soluble and platelet PECAM-1 after the first 24 hours after thrombolytic therapy may represent redistribution of the whole PECAM-1 pool.

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Section: Discussionmentioning

confidence: 99%

Effect of Thrombolytic Therapy on Platelet Expression and Plasma Concentration of PECAM-1 (CD31) in Patients With Acute Myocardial Infarction

Serebruany

Gurbel

1999

ATVB

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“…[1][2][3]8 The comparative efficacy and safety of initial aspirin dose in the setting of STEMI remain unknown. To date, there has been only a single randomized trial 11 that compared initial aspirin doses among those receiving fibrinolytic therapy, but unfortunately, the trial stopped early after enrolling only 162 patients.…”

Section: Clinical Perspective P 199mentioning

confidence: 99%

“…This potential inverse relationship between aspirin dose and cardiovascular efficacy may reflect the progressive inhibition of prostacyclin, similar to cyclooxygenase-2 inhibitors, thereby inducing platelet aggregation and vasoconstriction. 23,33 There has been only 1 single randomized study 11 that directly compared aspirin dose in STEMI. The Duke University Clinical Cardiology Group Study-II (DUCCS-II) compared the efficacy of 81-and 325-mg aspirin doses in 162 patients with STEMI treated with front-loaded tissue plasminogen activator or anisoylated plasminogen streptokinase activator complex.…”

Section: Aspirin Dose and Efficacymentioning

confidence: 99%

“…The Duke University Clinical Cardiology Group Study-II (DUCCS-II) compared the efficacy of 81-and 325-mg aspirin doses in 162 patients with STEMI treated with front-loaded tissue plasminogen activator or anisoylated plasminogen streptokinase activator complex. 11 No effect of aspirin dose on clinical outcomes was noted; however, because of its early termination, the study was severely underpowered to do so. The majority of data supporting the use of aspirin in the acute setting of a myocardial are from ISIS-2.…”

Section: Aspirin Dose and Efficacymentioning

confidence: 99%

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Initial Aspirin Dose and Outcome Among ST-Elevation Myocardial Infarction Patients Treated With Fibrinolytic Therapy

et al. 2008

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“…The evidence to support the equivalent efficacy of aspirin doses between 75 and 325 mg is mainly drawn from indirect comparisons between trials of different aspirin dose and direct comparisons in patients with cerebrovascular (5-7) or peripheral vascular (8) disease. There have been only two small direct comparisons of low and intermediate aspirin doses in patients with ACS, only one of which has been published (9). These failed to detect an effect of aspirin dose on outcome; however, they had extremely limited statistical power to do so.…”

mentioning

confidence: 99%

Aspirin dose and six-month outcome after an acute coronary syndrome

Quinn

Aronow

Califf

et al. 2004

Journal of the American College of Cardiology

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A randomized factorial trial of reperfusion strategies and aspirin dosing in acute myocardial infarction

Cited by 23 publications

References 18 publications

Effect of Thrombolytic Therapy on Platelet Expression and Plasma Concentration of PECAM-1 (CD31) in Patients With Acute Myocardial Infarction

Effect of Thrombolytic Therapy on Platelet Expression and Plasma Concentration of PECAM-1 (CD31) in Patients With Acute Myocardial Infarction

Initial Aspirin Dose and Outcome Among ST-Elevation Myocardial Infarction Patients Treated With Fibrinolytic Therapy

Aspirin dose and six-month outcome after an acute coronary syndrome

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