oronary thrombolysis has been shown to be beneficial and effective for the treatment of acute myocardial infarction (AMI) in many clinical randomized megatrials [1][2][3][4][5][6][7][8][9][10][11] and is now established as the standard reperfusion therapy. [12][13][14][15] However, the patency rate of the infarct-related artery (IRA) ranges between 60% and 80% with this treatment, and reocclusion occurs in 5-15% of cases. [16][17][18][19] The alternative therapy of primary percutaneous transluminal coronary angioplasty (PTCA) can achieve a recanalization rate as high as 90%, 20-24 but needs to be carried out within a short time frame. 14 In 1999, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients with AMI stated that primary PTCA is an alternative therapy for thrombolysis if it is performed in a timely fashion (balloon inflation within 90±30 min of admission) by persons skilled in the procedure and supported by experienced personnel in an appropriate laboratory environment. 15 The most crucial requirement for reperfusion therapy in AMI is not skill, but the earliest possible achievement of complete and sustained reperfusion. To this end, cocktail therapies using thrombolytic agents plus platelet glycoprotein IIb/IIIa inhibitors, 25,26 combination therapy with glycoprotein IIb/IIIa inhibitors and primary coronary intervention, 27 and a combination of thrombolysis and coronary intervention 28 have been attempted.The protocol for fibrinolysis and subsequent transluminal (FAST) therapy was prepared to establish a strategy for reperfusion therapy that complies with the 1996 ACC/AHA guidelines for the management of patients with AMI. 14 FAST therapy aims for the earliest possible thrombolysisin-myocardial-infarction grade 3 (TIMI-3) flow in the IRA after arrival in the emergency room.This study evaluated the efficacy and safety of FAST therapy. The FAST I trial using the tissue-type plasminogen activators (t-PA) alteplase or tisokinase as thrombolytic agents was performed from 1997 to 1998, and the FAST II trial comparing t-PA with the mutant t-PA monteplase was performed from 1998 to 1999.
Methods
Study SubjectsThe FAST trial was a prospective study conducted at 3 participating medical institutions. The study enrolled patients who presented after 30 min of continuous symptoms but within 12 h of the onset of symptoms of AMI and who had, on the basis of 12-lead electrocardiography (ECG) recording, ST-segment elevation of at least 0.1 mV in 2 or more limb leads, ST-segment elevation of at least 0.2 mV in the precordial leads, or bundle branch block. Patients were excluded from the study according to the following The efficacy and safety of fibrinolysis and subsequent transluminal (FAST) therapy were evaluated in 195 patients with acute myocardial infarction (AMI) for the early achievement of thrombolysis-in-myocardial-infarction grade 3 (TIMI-3) flow in the infarct-related artery. Intravenous thrombolysis using the optimal dose of a thrombolytic agent was in...