J Am Coll Cardiol. 2000 Nov 1;36(5):1489-96. Facilitation of early percutaneous coronary intervention after reteplase with or without abciximab in acute myocardial infarction: results from the SPEED (GUSTO-4 Pilot) Trial. Herrmann HC， Moliterno DJ， Ohman EM， Stebbins AL， Bode C， Betriu A， Forycki F， Miklin JS， Bachinsky WB， Lincoff AM， Califf RM， Topol EJ. Cardiovascular Division， Hospital of the University of Pennsylvania， Philadelphia 19104， USA.
OBJECTIVES: We examined the utility of early percutaneous coronary intervention (PCI) in a trial that encouraged its use after thrombolysis and glycoprotein IIb/IIIa inhibition for acute myocardial infarction (MI).
BACKGROUND: Early PCI has shown no benefit when performed early after thrombolysis alone.
METHODS: We studied 323 patients (61%) who underwent PCI with planned initial angiography， at a median 63 min after reperfusion therapy began. A blinded core laboratory reviewed cineangiograms. Ischemic events， bleeding， angiographic results， and clinical outcomes were compared between early PCI and no-PCI patients (n = 162)， between patients with Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 or 1 before PCI versus flow grade 2 or 3， and among three treatment regimens.
RESULTS: Early PCI patients showed a procedural success (<50% residual stenosis and TIMI flow grade 3) rate of 88% and a 30-day composite incidence of death， reinfarction， or urgent revascularization of 5.6%. These patients had fewer ischemic events and bleeding complications (15%) than did patients not undergoing early PCI (30%， p = 0.001). Early PCI was used more often in patients with initial TIMI flow grade 0 or 1 versus flow grade 2 or 3 (83% vs. 60%， p < 0.0001). Patients receiving abciximab with reduced-dose reteplase (5 U double bolus) showed an 86% incidence of TIMI grade 3 flow at approximately 90 min and a trend toward improved outcomes.
CONCLUSIONS: In this analysis， early PCI facilitated by a combination of abciximab and reduced-dose reteplase was safe and effective. This approach has several advantages for acute MI patients， which should be confirmed in a dedicated， randomized trial.