Prospective randomized trial of intravenous and intracoronary streptokinase in acute myocardial infarction.
Prospective randomized trial of intravenous and intracoronary streptokinase in acute myocardial infarction.
复制标题
静脉内和冠状动脉内链激酶治疗急性心肌梗死的前瞻性随机试验。
DOI：
10.1161/01.cir.68.5.1051
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发表时间：
1983
期刊：
影响因子：
37.8
通讯作者：
Soto,B
中科院分区：
文献类型：
--
作者：
Rogers,WJ;Mantle,JA;HoodJr,WP;Baxley,WA;Whitlow,PL;Reeves,RC;Soto,B
为了评估急性心肌梗死患者冠状动脉内与高剂量短期静脉输注链激酶的相对溶栓效果和并发症，我们进行了基线冠状动脉造影，然后随机分配51例急性心肌梗死患者接受冠状动脉内（n = 25）或静脉（n = 26）链激酶治疗。通过冠状动脉内途径给药的患者在1小时内接受24万IU的链激酶进入梗死相关动脉，而通过静脉给药的患者在15分钟内接受50万IU的链激酶（n = 10）或在45分钟内接受100万IU的链激酶（n = 16）。冠脉内注射链激酶患者血管造影观察溶栓率为76%(19/25)，静脉注射50万IU链激酶患者溶栓率为10%(1/10)，静脉注射100万IU链激酶患者溶栓率为44%（7/16）。在观察到溶栓的患者中，从开始输注到溶栓的平均时间，冠状动脉内输注的患者为31 +/- 18分钟，静脉输注的患者为38 +/- 20分钟（p = NS）。在静脉注射链激酶“失败”的患者中，冠状动脉内链激酶联合冠状动脉内导丝操作仅能再通7%（1/15）。静脉注射链激酶组（39 +/- 17 mg/dl） 6小时内纤维蛋白原水平明显低于冠脉内注射链激酶组（88 +/- 70 mg/dl） （p < 0.05）。0.05)，但两组在链激酶后24小时无明显差异。两组各有1例患者出血需要输血。因此，在这项冠脉内与静脉注射链激酶的前瞻性随机试验中，尽管两种方案都产生了全身溶解状态，但出血并发症很少。尽管冠状动脉内链激酶的溶栓效果优于高剂量短期静脉注射链激酶，但高剂量静脉注射方案（100万IU / 45分钟）在相当少数（44%）的患者中实现了溶栓，可能对无法获得紧急导管插入术的患者有用。
To evaluate the relative thrombolytic efficacy and complications of intracoronary vs high-dose, short-term intravenous streptokinase infusion in patients with acute myocardial infarction, we performed baseline coronary arteriography and then randomly allocated 51 patients with acute myocardial infarction to receive either intracoronary (n = 25) or intravenous (n = 26) streptokinase. Patients getting the drug by the intracoronary route received 240,000 IU of streptokinase into the infarct-related artery over 1 hr, whereas those getting the drug by the intravenous route received either 500,000 IU of streptokinase over 15 min (n = 10) or 1 million IU of streptokinase over 45 min (n = 16). Angiographically observed thrombolysis occurred in 76% (19/25) of the patients receiving intracoronary streptokinase, in 10% (1/10) of the patients receiving 500,000 IU of streptokinase intravenously, and in 44% (7/16) of the patients receiving 1 million IU of streptokinase intravenously. Among patients in whom thrombolysis was observed, mean elapsed time from onset of streptokinase infusion until lysis was 31 +/- 18 min in patients receiving intracoronary streptokinase and 38 +/- 20 min in those receiving intravenous streptokinase (p = NS). Among patients in whom intravenous streptokinase "failed," intracoronary streptokinase in combination with intracoronary guidewire manipulation recanalized only 7% (1/15). Fibrinogen levels within 6 hr after streptokinase were significantly lower in the patients receiving intravenous streptokinase (39 +/- 17 mg/dl) than the levels in those receiving intracoronary streptokinase (88 +/- 70 mg/dl) (p less than .05) but were similar 24 hr after streptokinase in the two groups. Bleeding requiring transfusion occurred in one patient in each group. Thus, in this prospective randomized trial of intracoronary vs intravenous streptokinase, hemorrhagic complications were few, although both regimens produced a systemic lytic state. Although the thrombolytic efficacy of intracoronary streptokinase was superior to that of high-dose, short-term intravenous streptokinase, the higher-dose intravenous regimen (1 million IU over 45 min) achieved thrombolysis in a significant minority (44%) of patients and might be useful therapy for patients not having access to emergency catheterization.