CARDIAC FINDINGS AFTER RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR THERAPY

53名患者（年龄61+或-11岁，34名男性）的心脏， 在心肌梗死溶栓研究（TIMI）中， 小时至260天（中位数2.6天）的胸痛发作后进行了研究。 53例患者中，38例接受重组组织型纤溶酶原激活剂治疗 （rt-PA）无经皮腔内冠状动脉成形术（PTCA）（9 患者）或冠状动脉旁路移植术（CABG）（6例患者）。 24例出血性脑梗死患者与20例 非出血性梗死患者显示：1） 心肌破裂（左心室游离壁或室间隔） [6(25心源性休克[9/22（41%）vs. 7例（44%）和致死性出血[2例（10%）/21例vs- 3例（19%）/16例]; 2） 在梗死相关动脉中血栓的相似频率[7（30% -vs. 7（37%）]，但出血性梗死患者的所有血栓均为 非闭塞性，非出血性梗死患者的所有血栓均为 闭塞性（p=.0002）;4）相似程度的管腔狭窄（0- 25%，26- 50%， 51- 75%，76- 95%，96-100%），在4个主要（左主干， 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的患者的动脉; 5）相似的平均百分比 由于斑块导致的横截面积缩小 通过面积测量法计算的梗死相关动脉（67 +或-10% -vs- 68 + 6）斑块破裂频率相似[13（57%）vs- 15（77%）; p=.12]; 7）斑块出血的频率相似[（16（80%）-vs. 14（74%）]; 8）出血性心脏病患者右心室梗死较少 梗死[2/11例后部出血性梗死-vs- 6/9例后部出血性梗死 非出血性梗死; p= 0.031.9）斑块相似， 泥质碎屑（13 +或- 11% -vs- 18 +或- 9%;，P= 0.18），钙化 沉积物（14 +或12% -vs- 20 +或- 14%; p= 0.25）和无细胞纤维 组织（49 +或14% -vs- 53 +或- 11%; p= 0.39）。

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).