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Eptifibatide and low-dose tissue plasminogen activator in acute myocardial infarction

The integrilin and low-dose thrombolysis in acute myocardial infarction (INTRO AMI) trial

Sorin J. Brener, MD, FACC^*,*, Uwe Zeymer, MD, FACC, A. A. Jennifer Adgey, MD, FACC, Thomas R. Vrobel, MD, FACC, Stephen G. Ellis, MD, FACC^*, Karl-Ludwig Neuhaus, MD, FACC¹, Nadine Juran, RN^*, Thomas B. Ivanc, MS^*, E. Magnus Ohman, MD, FACC^||, John Strony, MD, FACC^¶, Michael Kitt, MD, FACC^#, Eric J. Topol, MD, FACC^* for the INTRO AMI Investigators

^* Cleveland Clinic Foundation, Cleveland, Ohio, USA
Staedtische Kliniken, Kassel, Germany
Royal Victoria Hospital, Belfast, Ireland
MetroHealth Medical Center, Cleveland, Ohio, USA
^|| Duke Medical Center, Durham, North Carolina, USA
^¶ Schering-Plough Research Institute, Kenilworth, New Jersey, USA
^# COR Therapeutics, South San Francisco, California, USA

View larger version (19K): [in a new window]   Figure 1 Corrected Thrombolysis In Myocardial Infarction (TIMI) frame count for various sequences of administration of the components of the combination regimen. The vertical lines at 27 and 40 frames indicate the accepted upper limit of corrected TIMI frame count (cTFC) for TIMI flow grade 3 and the breakpoint between TIMI flow grades 3 and 2, respectively. t-PA = tissue plasminogen activator.

View larger version (20K): [in a new window]   Figure 2 Corrected Thrombolysis In Myocardial Infarction (TIMI) frame count for the dose confirmation phase. The vertical lines at 27 and 40 frames indicate the accepted upper limit of cTFC for TIMI flow grade 3 and the breakpoint between TIMI flow grades 3 and 2, respectively. t-PA = tissue plasminogen activator.

View larger version (33K): [in a new window]   Figure 3 (A) Incidence of Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 at 60 min in trials of combination therapy, adapted from references 3 and 4. (B) Median corrected TIMI frame count (cTFC) in trials of combination therapy, adapted from references 3 and 4. INTRO AMI = Integrilin and Low-Dose Thrombolysis in Acute Myocardial Infarction trial; SPEED = Strategies for Patency Enhancement in the Emergency Department.