A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction
A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction
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DOI：
10.1056/nejmoa025142
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发表时间：
2003-08-21
影响因子：
158.5
通讯作者：
Mortensen, LS
中科院分区：
文献类型：
--
作者：
Andersen, HR;Nielsen, TT;Mortensen, LS
背景对于ST段抬高的心肌梗死的治疗，对于那些住院接受血管成形术的患者，直接血管成形术被认为上级于纤溶。是否这种好处是保持患者谁需要从社区医院到一个中心，侵入性治疗是undetermined.METHODSWe随机分配1572例急性心肌梗死治疗血管成形术或加速治疗静脉阿替普酶; 1129例患者在24家转诊医院和443例患者在5侵入性治疗中心。主要研究终点是30天时死亡、再梗死临床证据或致残性卒中的复合终点。在转诊医院随机分组的患者中，血管成形术组8.5%的患者达到主要终点，纤溶组14.2%达到主要终点（P=0.002）。在介入治疗中心登记的患者中，结果相似：血管成形术组6.7%的患者达到主要终点，而纤溶组为12.3%（P=0.05）。在所有患者中，血管成形术后较好的结果主要是由于再梗死率的降低（血管成形术组为1.6%，纤溶组为6.3%，P
BACKGROUNDFor the treatment of myocardial infarction with ST-segment elevation, primary angioplasty is considered superior to fibrinolysis for patients who are admitted to hospitals with angioplasty facilities. Whether this benefit is maintained for patients who require transportation from a community hospital to a center where invasive treatment is available is uncertain.METHODSWe randomly assigned 1572 patients with acute myocardial infarction to treatment with angioplasty or accelerated treatment with intravenous alteplase; 1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 invasive-treatment centers. The primary study end point was a composite of death, clinical evidence of reinfarction, or disabling stroke at 30 days.RESULTSAmong patients who underwent randomization at referral hospitals, the primary end point was reached in 8.5 percent of the patients in the angioplasty group, as compared with 14.2 percent of those in the fibrinolysis group (P=0.002). The results were similar among patients who were enrolled at invasive-treatment centers: 6.7 percent of the patients in the angioplasty group reached the primary end point, as compared with 12.3 percent in the fibrinolysis group (P=0.05). Among all patients, the better outcome after angioplasty was driven primarily by a reduction in the rate of reinfarction (1.6 percent in the angioplasty group vs. 6.3 percent in the fibrinolysis group, P