Early coronary intervention following pharmacologic therapy for acute myocardial infarction (the combined TIMI 10B-TIMI 14 experience).
Early coronary intervention following pharmacologic therapy for acute myocardial infarction (the combined TIMI 10B-TIMI 14 experience).
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急性心肌梗死药物治疗后的早期冠状动脉介入治疗（结合 TIMI 10B-TIMI 14 经验）。
DOI：
10.1016/s0002-9149(01)01887-2
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
E. Braunwald
中科院分区：
文献类型：
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作者：
M. Schweiger;C. Cannon;S. Murphy;C. Gibson;James R. Cook;R. Giugliano;H. Changezi;E. Antman;E. Braunwald
早期研究表明，急性心肌梗死溶栓治疗后立即行经皮冠状动脉介入治疗与不良事件的增加有关，在这种情况下常规经皮冠状动脉介入治疗并不比保守治疗策略更具优势。为了在最近重新评估这一问题，我们评估了1,938名来自心肌梗死溶栓试验(TIMI)10B和14项急性心肌梗死试验的患者。TIMI 10B试验的患者随机接受组织纤溶酶原激活剂或TNK组织纤溶酶原激活剂治疗，而TIMI 14B试验的患者随机接受阿昔单抗或不使用阿昔单抗溶栓治疗。所有患者在接受药物治疗90分钟后进行血管造影。接受经皮冠状动脉介入治疗的患者分为抢救(90分钟时TIMI为0或1)、辅助手术(90分钟时TIMI为2或3)或延迟手术(症状出现150分钟后实施，中位数为2.75天)。在TIMI为0或1的患者中，接受补救性经皮冠状动脉介入治疗的患者的30天死亡率有降低的趋势(6%比17%，p=0.01，调整后的p=0.28)。接受辅助经皮冠状动脉介入治疗的患者与接受延迟经皮冠状动脉介入治疗的患者相比，30天的死亡率和/或再梗死情况相似。在多变量模型中，两者的30天死亡率和/或再梗死率均低于未接受血运重建的患者(P=0.02)。因此，急性心肌梗死后早期经皮冠状动脉介入治疗与良好的预后相关。溶栓后早期侵入性策略的随机试验是有必要的。
Earlier studies have suggested that immediate percutaneous coronary intervention (PCI) following thrombolytic therapy for acute myocardial infarction (AMI) is associated with an increase in adverse events and that routine PCI in this setting has offered no advantage over a conservative strategy. To reassess this issue in a more recent era, we evaluated 1,938 patients from the Thrombolysis in Myocardial Infarction (TIMI) 10B and 14 trials of AMI. Patients in TIMI 10B were randomized to receive tissue plasminogen activator or TNK tissue plasminogen activator, whereas patients in TIMI 14B trial were randomized to receive thrombolytic therapy with or without abciximab. All patients underwent angiography 90 minutes after receiving pharmacologic therapy. Patients who underwent PCI were classified as having undergone a rescue procedure (TIMI 0 or 1 flow at 90 minutes), an adjunctive procedure (TIMI 2 or 3 flow at 90 minutes), or a delayed procedure (performed >150 minutes after symptom onset, median of 2.75 days). Among patients with TIMI 0 or 1 flow, there was a trend for lower 30-day mortality among patients who underwent rescue PCI than among those who did not (6% vs 17%, p = 0.01, adjusted p = 0.28). Patients who underwent adjunctive PCI had similar 30-day mortality and/or reinfarction as those who underwent delayed PCI. In a multivariate model both had lower 30-day mortality and/or reinfarction than patients with “successful thrombolysis” (i.e., TIMI 3 flow at 90 minutes) who did not undergo revascularization (p = 0.02). Thus, early PCI following AMI is associated with excellent outcomes. Randomized trials of an early invasive strategy following thrombolysis are warranted.