Sustained improvement in left ventricular function and mortality by intracoronary streptokinase administration during evolving myocardial infarction.
Sustained improvement in left ventricular function and mortality by intracoronary streptokinase administration during evolving myocardial infarction.
复制标题
在心肌梗死发展过程中，冠状动脉内给予链激酶可持续改善左心室功能和死亡率。
DOI：
10.1161/01.cir.68.1.131
复制
发表时间：
1983
期刊：
影响因子：
37.8
通讯作者：
Gould,KL
中科院分区：
文献类型：
--
作者：
Smalling,RW;Fuentes,F;Matthews,MW;Freund,GC;Hicks,CH;Reduto,LA;Walker,WE;Sterling,RP;Gould,KL
1980年8月至1982年9月，对188例急性心肌梗塞患者进行了前瞻性研究。其中136例患者在获得知情同意后进入冠状动脉内链激酶研究。其余52例符合研究排除标准或拒绝参加的患者作为对照组，除未接受紧急心导管插入术外，均接受与研究组相同的治疗。在两组患者入院时、出院时和出院后6个月通过门控放射性核素射血分数（EF）测定左心室功能。在胸痛发作后18小时内成功再灌注，研究组的平均左心室功能改善（入院时EF 39 +/- 13%，出院时EF 46 +/- 12%; p <0.001）。对照组患者和未实现再灌注的患者的平均EF从入院到出院没有变化。研究组或对照组6个月随访时的平均EF与出院时无显著差异。对照组的总心源性死亡率为19%，而研究组为10%（p = 0.06，NS）。当从两组中排除因肺水肿或休克（Killip III级或IV级）入院的患者时，研究组的总心脏死亡率（4%）显著低于对照组（12.5%，p <0.05）。在胸痛发作后18小时内进行性心肌梗死期间冠状动脉内链激酶给药可能导致死亡率降低和左心室功能持续改善。
One hundred eighty-eight patients with acute myocardial infarction were studied prospectively from August 1980 to September 1982. One hundred thirty-six of these patients were entered into a intracoronary streptokinase study after informed consent was obtained. The remaining 52 patients, who either met exclusion criteria for the study or refused to participate, served as a control group and were treated as those in the study group except that they did not undergo emergency cardiac catheterization. Left ventricular function was determined in both groups by gated radionuclide ejection fraction (EF) on admission to the hospital, at discharge, and 6 months after discharge. With successful reperfusion up to 18 hr after onset of chest pain, mean left ventricular function in the study group improved (EF 39 +/- 13% on admission and 46 +/- 12% at discharge; p less than .001). Mean EF in control patients and those not achieving reperfusion did not change from admission to discharge. Mean EF at 6 month follow-up was not significantly different than at discharge in the study group or the control group. Total cardiac mortality in the control group was 19% compared with 10% in the study group (p = .06, NS). When patients admitted in pulmonary edema or shock (Killip class III or IV) were excluded from both groups, total cardiac mortality in the study group was significantly lower (4%) compared with in the control group (12.5%, p less than .05. The administration of intracoronary streptokinase during evolving myocardial infarction up to 18 hr after onset of chest pain may result in decreased mortality and sustained improvement in left ventricular function.