CARDIAC FINDINGS AFTER RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR THERAPY

重组组织纤溶酶原激活剂治疗后的心脏检查结果

• 批准号: 3879015
• 负责人: W C ROBERTS
• 金额: --
• 依托单位: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3879015
• 关键词: angina pectoris; coronary bypass; coronary disorder; fibrinolysis; human middle age (35-64); human tissue; intraluminal angioplasty; male; pathology; plasminogen activator; postmortem

The hearts of 53 patients (aged 61+ or -11 years, 34 men) who participated in the Thrombolysis in Myocardial Infarction Study (TIMI) and died from 5 hours to 260 days (median 2.6 days) after onset of chest pain were studied. Of the 53 patients, 38 received recombinant tissue plasminogen activator (rt-PA) without percutaneous transluminal coronary angioplasty (PTCA) (9 patients) or coronary artery bypass grafting (CABG) (6 patients). Comparisons between the 24 patients with hemorrhagic infarcts and the 20 patients with non-hemorrhagic infarcts showed: 1) similar frequencies of myocardial rupture (left ventricular free wall or ventricular septum) [6(25%) of 24 -vs- 5(25%) of 201, cardiogenic shock [9(41%) of 22 -vs- 7(44%) of 16), and fatal hemorrhage [2(10%) of 21 -vs- 3(19%) of 16]; 2) similar frequencies of thrombi in the infarct-related arteries [7(30% -vs- 7(37%)], but all thrombi in patients with hemorrhagic infarcts were non-occlusive, and all thrombi in those with non-hemorrhagic infarcts were occlusive (p=.0002);4) similar degrees of luminal narrowing (0-25%, 26-50%, 51-75%, 76-95%, 96-100%) in all 5-mm segments of the 4 major (left main, left anterior descending, left circumflex and right) epicardial coronary arteries in 27 patients receiving rt-PA alone; 5) similar mean percent reduction in cross-sectional area narrowing by plaque of the infarct-related arteries calculated by planimetry (67 + or -10% -vs- 68 + or -9%); 6) similar frequencies of plaque rupture [13(57%) - vs- 15(77%); p=.12]; 7) similar frequencies of hemorrhage into a plaque [(16(80%) -vs- 14(74%)]; 8) fewer right ventricular infarcts in patients with hemorrhagic infarcts [2 of 11 posterior hemorrhagic infarcts -vs- 6 of 9 posterior non-hemorrhagic infarcts; p=.031.9) similar percents of plaque with pultaceous debris (13 + or - 11% -vs- 18 + or - 9%; ,P=.18), calcific deposits (14 + or 12% -vs- 20 + or - 14%; p=.25), and acellular fibrous tissue (49 + or 14% -vs- 53 + or - 11%; p=.39).

53例患者(年龄61岁或-11岁，34名男性)的心脏 在心肌梗死溶栓研究(TIMI)中死亡，死于5岁 研究对象为胸痛发作后数小时至260天(中位数2.6天)。 在53例患者中，38例接受了重组组织型纤溶酶原激活剂 (rt-PA)非经皮冠状动脉腔内成形术(PTCA)(9 冠脉搭桥术(CABG)6例。 出血性脑梗塞24例与20例的比较 非出血性脑梗塞患者显示：1)相似的频率 心肌破裂(左心室游离壁或室间隔) 心源性休克201例中6例(25%)，22例中9例(41%) 7例(44%)和致命性出血[21例中2例(10%)，16例中3例(19%)]； 梗塞相关动脉血栓发生率相似[7(30%-vs- 7(37%)]，但出血性脑梗塞患者的所有血栓均为 非闭塞性，非出血性梗死者所有血栓均为 闭塞(p=.0002)；4)管腔狭窄程度相似(0-25%，26-50%， 51-75%、76-95%、96-100%)。 左前降支、左回旋支和右)心外膜冠状动脉 27例单独接受rt-PA治疗的患者的动脉；5)相似的平均百分比 颈动脉斑块引起的横截面积缩小 用平面测量法计算梗塞相关动脉(67+或-10%-vs-68+ 斑块破裂频率相近[13(57%)-15(77%)； P=.12]；7)斑块出血频率相似[(16(80%)-vs- 14(74%)]；8)出血性患者较少的右室梗塞 梗塞[11个后部出血性梗塞中的2个--9个后部中的6个 非出血性脑梗塞；p=.031.9)斑块百分比与 牙髓碎屑(13+或-11%-vs-18+或-9%；，P=.18)，钙化 沉积物(14+或12%-vs-20+或-14%；p=0.25)，以及无细胞纤维 组织(49+或14%-vs-53+或-11%；p=.39)。