The effect of taprostene in patients with acute myocardial infarction treated with thrombolytic therapy: results of the STARTstudy

Taprostene is a prostacyclin analogue that inhibits plateletaggregation and thus might be a useful adjuvant to thrombolyticagents in acute myocardial infarction. In a placebo-controlled dose rising study, taprostene or placebowas intravenously infused in 80 patients treated with the thrombolyticagent saruplase (rscu-PA) for acute myocardial infarction. Threedoses of taprostene were used: 6.25; 12.5; or 25.0 ng.kg^–1.min^–1.Taprostene or placebo was infused for 48 h, followed by a 24h tapering period. All 80 patients had short symptom-to-treatmentdelay and marked ST segment elevation. Patency at 90 min was documented in 58/78 patients (two patientshad no angiography). Success rate varied from 67–82% inthe four treatment arms (P=0.33). Patency after rescue PTCAwas seen in 10 out of 13 patients. Of the 58 patients havinga patent artery at 90 min, none of the 43 taprostene patientsand one of the 15 placebo patients had a reoccluded artery atthe second angiography at 32–48 h (5/58 patients had norecatheterization). Conversely, of nine patients who had successfulrescue PTCA, three of four placebo patients had a re-occludedartery at the second angiography compared to one of five taprostenepatients (one placebo patient had no recatheterization) (P=0.33). Safety evaluation revealed no major difference betweenthe placebo plus saruplase and the taprostene plus saruplasegroups. Taprostene was well tolerated up to 25 ng.kg^–1 .min^–1.Although taprostene did not affect 90 min patency, there wasa trend to better maintenance of patency after rescue PTCA.