Coronary perfusion during acute myocardial infarction with a combined therapy of coronary angioplasty and high-dose intravenous streptokinase.
Coronary perfusion during acute myocardial infarction with a combined therapy of coronary angioplasty and high-dose intravenous streptokinase.
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急性心肌梗死期间冠状动脉灌注联合冠状动脉血管成形术和大剂量静脉注射链激酶的治疗。
DOI：
10.1161/01.cir.77.1.151
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发表时间：
1988
期刊：
影响因子：
37.8
通讯作者：
Carlson,EB
中科院分区：
文献类型：
--
作者：
Stack,RS;O'Connor,CM;Mark,DB;Hinohara,T;Phillips,HR;Lee,MM;Ramirez,NM;O'Callaghan,WG;Simonton,CA;Carlson,EB
本文报告216例急性心肌梗死患者在急诊冠状动脉成形术后立即静脉滴注大剂量链激酶组。99%的患者梗死灶交叉扩张，90%的患者术后冠状动脉持续灌注(包括3%的患者有明显的残余狭窄)。住院总死亡率为12%。多变量分析显示，心源性休克患者的住院死亡率较高(41%比5%)，年龄较大，左心室射血分数较低，女性。梗塞相关血管的最终通畅率通过院内心导管术的随访来确定。冠状动脉再闭塞的发生率为11%(有症状的7%接受紧急血管成形术或搭桥手术；4%的患者无症状，接受内科治疗)。在成功初步建立梗死区血管通畅的存活患者中，94%的患者通过开放的梗死区动脉或通向梗塞区的搭桥出院。在随访心导管术时，持续冠脉灌注和无明显残余狭窄的患者在梗死区的射血分数(44%至49%；p<0.0001)和局部室壁运动(-3.0SD至-2.4SD；p<0.0001)均有显著改善。因此，急性心肌梗死的治疗策略包括立即给予链激酶，然后进行紧急冠状动脉血管成形术，并在必要时进行冠状动脉搭桥手术，从而导致与梗死相关的血管早期和持续通畅率高。
Two hundred and sixteen patients with acute myocardial infarction were treated with immediate infusion of high-dose (1.5 million units) intravenous streptokinase followed by emergency coronary angioplasty. The infarct lesion was crossed and dilated in 99% and persistent coronary perfusion after the procedure was achieved in 90% (including 3% with significant residual stenosis). Total in-hospital mortality was 12%. Multivariable analysis showed a higher hospital mortality with cardiogenic shock (41% vs 5% without shock), older age, lower left ventricular ejection fraction, and female sex. Final patency of the infarct-related vessel was determined by follow-up in-hospital cardiac catheterization. Coronary reocclusion occurred in 11% (symptomatic in 7%, treated with emergency angioplasty or bypass surgery; silent in 4%, treated medically). Of the surviving patients with successful initial establishment of infarct vessel patency, 94% were discharged from the hospital with an open infarct artery or a bypass graft to the infarct vessel. There was significant improvement in both ejection fraction (44% to 49%; p less than .0001) and regional wall motion in the infarct zone (-3.0 SD to -2.4 SD; p less than .0001) among patients with persistent coronary perfusion and insignificant residual stenosis at the time of the follow-up cardiac catheterization. Thus, a treatment strategy for acute myocardial infarction that includes immediate administration of streptokinase followed by emergency coronary angioplasty, and coronary bypass surgery when necessary, results in a high rate of early and sustained patency of the infarct-related vessel.