Intracoronary fibrinolytic therapy in acute myocardial infarction: Preliminary report of a randomized trial
Intracoronary fibrinolytic therapy in acute myocardial infarction: Preliminary report of a randomized trial
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急性心肌梗死的冠脉内纤溶治疗：随机试验的初步报告
DOI：
10.1016/0002-9149(82)92251-2
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发表时间：
1982
影响因子：
2.8
通讯作者：
A. Goldberg
中科院分区：
文献类型：
--
作者：
F. Khaja;E. Lô;L. Osterberger;J. Walton;J. Brymer;William W. O'Neill;S. Goldstein;B. Pitt;Tennyson G. Lee;A. Goldberg
心脏血管造影学会有一个大型的导管室登记处。基线临床和血管造影数据以及冠状动脉内链激酶输注治疗急性心肌梗死（AMI）的技术和结果正在汇编中。数据收集于1981年7月1日开始。截至1981年9月10日，9个实验室报告了44例病例。从症状发作到住院的时间为78 ± 142分钟，到链激酶治疗（SKT）的时间为254 ± 183分钟。有26例前壁和18例下壁AMI，42/44例血栓性闭塞，42例在SKT发作时持续胸痛。冠状动脉内硝酸甘油开放了3143条血管，29142条（69%）血管开放，平均链激酶剂量为173，000单位。2例患者在1小时内发生再闭塞，7例患者在晚期（6-15天）发生再闭塞。再灌注后，平均射血分数（EF）从溶栓前的42%增加到溶栓后8-60天的52%（p<0.05）。OOlj。在未进行溶栓治疗的患者中，EF无变化（治疗前41%，治疗后38%）。29例溶解患者中有9例接受了CABG手术，1例未溶解患者接受了手术; 44例患者中有37例发生了Q波梗死。无死亡，7例（16%）严重并发症（4例室颤，2例出血，1例休克）。血管造影师判断SKT获益为50%，无获益为30%，获益不确定为20%。大约一半的治疗患者获益。这可能会随着早期治疗和/或改进的输注技术而增加。来自许多实验室的数据正在进行登记，这将有助于对这种新的和不断发展的急性心肌梗死治疗方法进行现实的评估。
The Society for Cardiac Angiography maintains a large catheterization laboratory registry. Baseline clinical, and angiographic data and the technique and results of intracoronary streptokinase infusion for the treatment of acute myocardial infarction (AMI) are being compiled. Data collection was initiated 7/l/81. Nine laboratories reported 44 cases by 9/10/81. Time from onset of symptoms to hospitalization was 78+ 142 minutes and to streptokinase treatment (SKT), 254+ 183 minutes. There were 26 anterior and 18 inferior AMI, 42/44 with thrombotic occlusion, and 42 with ongoing chest pain at onset of SKT. Intracoronary nitroglycerin opened 3143 vessels and 29142 (69%) opened with a mean dose of 173,000 units of streptokinase. Two patients had reocclusion within 1 hour and 7 were known to reocclude late (6-15 days). With reperfusion, mean ejection fraction (EF) increased from 42% before to 52% 8-60 days after lysis (p<. OOlj. In patients without thrombolysis EF was unchanged (pre 41%, post 38%). Nine of 29 patients with lysis had CABG surgery, and 1 patient without lysis had surgery; 37/44 patients evolved a Q-wave infarct. There were no deaths, and 7 (16%) major complications (4 V fib, 2 hemorrhage, 1 shock). The angiographer judged SKT of benefit in SO%, no benefit in 30% and of uncertain benefit in 20%.Successful thrombolysis appears to limit AM1 size as judged by improved late EF. Benefit occurs in approximately half of treated patients. This may increase with earlier treatment and/or improved infusion techniques. An ongoing registry of data from many laboratories will help provide a realistic assessment of this new and evolving treatment of acute myocardial infarction.