Because acute myocardial infarction (AMI) and unstable angina have a common pathogenesis, early thrombolytic treatment, proven to be highly beneficial in patients with AMI, may also be suitable for treating patients with severe unstable angina. A randomized, single-blind, multicenter, prospective, pilot study was conducted to determine whether early treatment with recombinant tissue type plasminogen activator (rt-PA) followed by a 3-day continuous heparin infusion and aspirin could reduce the 1-month incidence of unfavorable outcome (cardiovascular death, AMI, or recurrent angina at rest) in patients with acute angina at rest associated with ischemic electrocardiographic changes. Of the 60 patients enrolled in the trial, 30 were randomly assigned to receive rt-PA plus heparin and aspirin (rt-PA group) and 30 received heparin and aspirin alone (heparin group). An unfavorable outcome occurred in 7 (23.3%) of the 30 patients treated with rt-PA and in 13 (43.3%) of the 30 patients treated with heparin (odds ratio, 0.39; 95% CI, 0.13-1.2). One (3.3%) patient in the rt-PA group and five (16.6%) in the heparin group (16.6%) died or suffered a non-fatal AMI (odds ratio, 0.17; 95% CI, 0.02-1.6). Four patients died, all in the heparin group. The results of this study suggest that early treatment with rt-PA can improve the clinical outcome of unstable angina in a specific subgroup of patients with acute angina at rest.
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