Results of the RAPID 1 and RAPID 2 thrombolytic trials in acute myocardial infarction.

Abstract

Two angiographic trials, RAPID 1 in 606 patients and RAPID 2 in 324 patients, assessed angiographic patency after acute myocardial infarction following treatment with reteplase and alteplase. RAPID 1 evaluated three bolus regimens of reteplase in comparison with a 3 h infusion of alteplase. RAPID 2 compared the 10 MU + 10 MU double bolus regimen of reteplase with the accelerated regimen (90 min infusion) of alteplase. The results of these studies showed that reteplase opened more arteries more quickly than did alteplase. Angiography at both 60 and 90 min showed a higher rate of patency and greater TIMI (Thrombolysis in Myocardial Infarction perfusion grade) 3 flow rates with reteplase than with alteplase. In RAPID 1, at 90 min, TIMI 3 flow rates were 63% for reteplase compared to 49% for alteplase (P < 0.05), and in RAPID 2, TIMI 3 flow was 60% vs 45%, respectively, (P < 0.05). Reteplase was convenient and simple to administer, and there were no unexpected complications. Fewer interventional procedures were performed after therapy with reteplase than with alteplase, primarily because coronary angioplasty was required less frequently following acute angiography in patients receiving reteplase. The angiographic profile for reteplase demonstrated in these two trials suggests that this new thrombolytic drug has potential advantages over alteplase: notably, its use can result in earlier and more complete coronary patency. The clinical significance of this finding must be determined in larger clinical trials.