Usefulness of a pericardial friction rub after thrombolytic therapy during acute myocardial infarction in predicting amount of myocardial damage. The TAMI Study Group.
Usefulness of a pericardial friction rub after thrombolytic therapy during acute myocardial infarction in predicting amount of myocardial damage. The TAMI Study Group.
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急性心肌梗死期间溶栓治疗后心包摩擦音在预测心肌损伤程度中的作用。
DOI：
10.1016/0002-9149(90)90526-7
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Topol,EJ
中科院分区：
文献类型：
--
作者：
Wall,TC;Califf,RM;Harrelson-Woodlief,L;Mark,DB;Honan,M;Abbotsmith,CW;Candela,R;Berrios,E;Phillips,HR;Topol,EJ
为评价溶栓治疗后心包炎的临床发生率和预后，对810例急性心肌梗死(AMI)患者进行前瞻性研究。心包炎的定义是在住院期间出现心包摩擦摩擦。只有5%的患者在急性心肌梗死期间出现摩擦，与溶栓前相比，这一比例较低。心包摩擦更多发生在前壁急性心肌梗死时。与无心包摩擦的患者相比，有心包摩擦的患者的射血分数较低(45vs51%，p=0.002)；局部左心功能较差(−3.2vs2.7，每弦标准差)；住院死亡率较高(15vs6%，p=0.056)；电源故障的频率更高(83vs57%)；急性心肌梗死的前壁位置较高(53%的病例，p=0.002)；以及较高的三支血管病变频率。因此，尽管与溶栓前相比，心包摩擦的发生率(5%)较低，但它的发生意味着更广泛的心肌损害，临床结果更差。随着梗塞相关血管的成功再通，可能可以防止跨壁心肌坏死和心包炎的发展。任何出现心包摩擦摩擦的患者临床上都没有发生心脏压塞。
To evaluate the clinical incidence and outcomes of patients with pericarditis after thrombolytic therapy, 810 patients were prospectively studied during acute myocardial infarction (AMI). Pericarditis was defined as the presence of a pericardial friction rub during the hospital course. Only 5% of patients developed a rub during AMI, a low percent compared with that in the prethrombolytic era. A pericardial friction rub more often occurred in the setting of an anterior wall AMI. Patients with, compared to those without, a pericardial friction rub had lower ejection fractions (45 vs 51%, p = 0.002); worse regional left ventricular function (−3.2 vs 2.7, standard deviation per chord); higher in-hospital mortality (15 vs 6%, p = 0.056); a higher frequency of power failure (83 vs 57%); a higher frequency of anterior wall location of the AMI (53% of cases, p = 0.002); and a higher frequency of 3-vessel disease. Therefore, although the frequency of a pericardial friction rub was low (5%) compared with that in the prethrombolytic era, its occurrence denotes more extensive myocardial damage with a worse clinical outcome. Perhaps with successful reperfusion of the infarct-related vessel, transmural myocardial necrosis is prevented and with it the development of pericarditis. Cardiac tamponade did not occur clinically in any patient who developed a pericardial friction rub.