Another angiographic study, Strategies for Patency Enhancement in the Emergency Department (SPEED) tested rPA with abciximab (vs rPA alone) in 2 phases (140). The best combination in phase A (half-dose rPA—5U + 5U 30 min apart—with full dose abciximab) was re-evaluated in phase B with two heparin bolus doses (40 or 60 U/kg). Improved TIMI-3 flow rates were observed with combination therapy, 54 vs 47%, although differences were not significant. Higher rates of bleeding (9.8 vs 3.7%) were observed with combination therapy. SPEED piloted the GUSTO-V AMI outcomes trial.

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