GLOBAL AND REGIONAL LEFT-VENTRICULAR FUNCTION AND TOMOGRAPHIC RADIONUCLIDE PERFUSION - THE WESTERN WASHINGTON INTRACORONARY STREPTOKINASE IN MYOCARDIAL-INFARCTION TRIAL
GLOBAL AND REGIONAL LEFT-VENTRICULAR FUNCTION AND TOMOGRAPHIC RADIONUCLIDE PERFUSION - THE WESTERN WASHINGTON INTRACORONARY STREPTOKINASE IN MYOCARDIAL-INFARCTION TRIAL
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DOI：
10.1161/01.cir.70.5.867
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发表时间：
1984-01-01
期刊：
影响因子：
37.8
通讯作者：
KENNEDY, JW
中科院分区：
文献类型：
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作者：
RITCHIE, JL;DAVIS, KB;KENNEDY, JW
西华盛顿冠脉内链激酶治疗心肌梗死试验纳入250名急性心肌梗死患者。在冠状动脉造影诊断为血栓形成后，患者被随机分配到接受常规肝素治疗或冠脉内链激酶加肝素治疗。在存活至少60天的232名患者中，207名(89%)在单一机构接受了放射性核素左心室造影术，测定整体和局部射血分数为62。+-。脑梗塞后35天。在前100例患者中，用201Tl定量单光子发射断层成像测定梗塞面积，并以有血流灌注缺陷的左心室的百分比表示。总体而言，接受链激酶治疗的患者的整体射血分数没有差异(45.9.+-.13.9%；n=115)和对照组(46.1.+-)。14.4%；n=92，P=NS[无显著意义]。同样，区域后外侧射血分数、下射血分数和前间隔射血分数在两组之间没有差异。201Tl断层扫描测得心肌梗死面积为19.4±-。链激酶组左心室占12.8%(n=52)，19.6%+-。对照组为11.8%(n=48；P=NS)。当按梗塞部位、治疗时间或有无血管开放在组内比较时，链激酶组与对照组之间无显著差异。统计纳入18名过早死亡和无法进行研究的患者也未能修改结果，除了201Tl断层扫描测量的下壁梗塞范围可能缩小。在心肌梗死后8wk测量时，201Tl断层扫描测定的整体和局部左室泵功能和梗塞范围在接受链激酶组和接受常规治疗的患者之间没有显著差异。
The Western Washington Intracoronary Streptokinase In Myocardial Infarction Trial enrolled 250 patients with acute myocardial infarction. After the coronary angiographic diagnosis of thrombosis, patients were randomly assigned to receive either conventional therapy with heparin or intracoronary streptokinase followed by heparin. Of the 232 patients who survived at least 60 days, 207 (89%) underwent radionuclide ventriculographic determination of global and regional ejection fraction at a single institution at 62 .+-. 35 days after infarction. In the 1st 100 patients, infarct size was also determined by quantitative single-photon emission tomographic imaging with 201Tl and expressed as a percentage of the left ventricle with a perfusion defect. Overall, global ejection fraction did not differ between patients treated with streptokinase (45.9 .+-. 13.9%; n = 115) and control patients (46.1 .+-. 14.4%; n = 92, P = NS [not significant]). Similarly, the regional posterolateral, inferior and anteroseptal ejection fraction did not differ between the 2 groups. Infarct size as measured by 201Tl tomography was 19.4 .+-. 12.8% (n = 52) of the left ventricle for the streptokinase group and 19.6 .+-. 11.8% (n = 48; P = NS) for the control group. When patients were compared within groups by ECG location of infarction, time to treatment, or the presence or absence of vessel opening, there were no significant differences between streptokinase and control patients. Statistical inclusion of the 18 patients who died early and were unavailable for study also failed to modify the results, except for a possible reduction in inferior infarct size as measured by 201Tl tomography. Global and regional left ventricular pump function and infarct size determined by 201Tl tomography apparently did not differ substantially between patients receiving streptokinase and those receiving conventional treatment when measured 8 wk after myocardial infarction.