Juliard J M, Himbert D, Cristofini P, Desportes J C, Magne M, Golmard J L, Aubry P, Benamer H, Boccara A, Karrillon G J, Steg P G
Cardiology Department, Hôpital Bichat, Paris, France.
Am J Cardiol. 1999 Feb 1;83(3):305-10. doi: 10.1016/s0002-9149(98)00858-3.
This study sought to assess the rate of acute Thrombolysis In Myocardial Infarction (TIMI) trial grade 3 patency that can be achieved with the combination of prehospital thrombolysis and standby rescue angioplasty in acute myocardial infarction. No large angiographic study has been performed after prehospital thrombolysis to determine the 90-minute TIMI 3 patency rate in the infarct-related artery. Hospital outcome and artery patency were compared to 170 matched patients treated with primary angioplasty. Prehospital thrombolysis was applied 151+/-61 minutes after the onset of pain in 170 patients (56+/-12 years, 86% men), using recombinant tissue-type plasminogen activator, streptokinase, or eminase. Emergency 90-minute angiography was performed in every case. All patients in whom thrombolysis failed underwent rescue angioplasty. After thrombolysis alone, TIMI grade 3 flow in the infarct-related artery was observed in 108 patients (64%), TIMI grade 2 in 12 (7%), and TIMI grade 0 or 1 in 50 (29%). Rescue angioplasty was successful in 47 of 50 attempts. Overall, TIMI 3 patency was achieved in 91%, and additionally TIMI 2 flow in 7% of patients, an average of 113+/-39 minutes after thrombolysis and 55+19 minutes after admission. Therefore, < 2 hours after thrombolysis, only 2% of patients had persistent occlusion (TIMI 0 or 1) of the infarct-related artery. In-hospital mortality was 4% overall (7 of 170), and 3% in the 155 patients in whom TIMI 3 was obtained during the acute phase. Severe hemorrhagic complications occurred in 14 patients (8%) with 2 fatal cerebral hemorrhages (7% of patients required transfusions). The matched comparison with primary PTCA showed no significant difference in hospital outcome. Combined prehospital thrombolysis, 90-minute angiography, and rescue angioplasty yield a high rate of acute TIMI 3 patency rate early after thrombolysis and hospital admission. A randomized, prospective comparison between these 2 reperfusion strategies may be now warranted.
本研究旨在评估院前溶栓与备用抢救性血管成形术联合应用于急性心肌梗死时，急性心肌梗死溶栓治疗（TIMI）试验3级通畅率的可实现程度。此前尚未有大型血管造影研究在院前溶栓后进行，以确定梗死相关动脉90分钟TIMI 3级通畅率。将住院结局和动脉通畅情况与170例接受直接血管成形术治疗的匹配患者进行比较。170例患者（年龄56±12岁，男性占86%）在疼痛发作后151±61分钟接受院前溶栓治疗，使用重组组织型纤溶酶原激活剂、链激酶或阿尼普酶。每例患者均进行90分钟急诊血管造影。所有溶栓失败的患者均接受抢救性血管成形术。单独溶栓后，108例患者（64%）梗死相关动脉观察到TIMI 3级血流，12例（7%）为TIMI 2级，50例（29%）为TIMI 0级或1级。50次抢救性血管成形术尝试中有47次成功。总体而言，91%的患者实现了TIMI 3级通畅，另外7%的患者为TIMI 2级血流，溶栓后平均113±39分钟、入院后55±19分钟达到。因此，溶栓后<2小时，仅2%的患者梗死相关动脉存在持续性闭塞（TIMI 0级或1级）。总体住院死亡率为4%（170例中有7例），急性期获得TIMI 3级的155例患者中为3%。14例患者（8%）发生严重出血并发症，2例致命性脑出血（7%的患者需要输血）。与直接经皮冠状动脉腔内血管成形术（PTCA）的匹配比较显示住院结局无显著差异。院前溶栓、90分钟血管造影和抢救性血管成形术联合应用可在溶栓和入院后早期获得较高的急性TIMI 3级通畅率。现在可能有必要对这两种再灌注策略进行随机、前瞻性比较。
