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Early, complete, and sustained reperfusion after myocardial infarction is known to decrease 30-day mortality. This study asked whether reteplase, a recombinant plasminogen activator administered in two boluses, can improve patency and reduce mortality as compared with alteplase, given by accelerated infusion over 90 minutes.
The study enrolled 15,059 patients with acute MI from 20 countries. Baseline characteristics of the reteplase and alteplase groups were similar, and the time from symptom onset to treatment was 2.7 hours in each. Mortality at 30 days was 7.47% with reteplase and 7.24% with alteplase. Stroke occurred in 1.64% and 1.79% of patients, respectively; the combined endpoint of death or disabling stroke occurred in 7.89% and 7.91…