前壁心肌梗死的直接血管成形术与全身溶栓治疗对比

Primary angioplasty versus systemic thrombolysis in anterior myocardial infarction.

作者信息

García E, Elízaga J, Pérez-Castellano N, Serrano J A, Soriano J, Abeytua M, Botas J, Rubio R, López de Sá E, López-Sendón J L, Delcán J L

机构信息

Division of Cardiology, Gregorio Marañón University General Hospital, Madrid, Spain.

出版信息

J Am Coll Cardiol. 1999 Mar;33(3):605-11. doi: 10.1016/s0735-1097(98)00644-5.

DOI:10.1016/s0735-1097(98)00644-5

PMID:10080458

Abstract

OBJECTIVES

This study compares the efficacy of primary angioplasty and systemic thrombolysis with t-PA in reducing the in-hospital mortality of patients with anterior AMI.

BACKGROUND

Controversy still exists about the relative benefit of primary angioplasty over thrombolysis as treatment for AMI.

METHODS

Two-hundred and twenty patients with anterior AMI were randomly assigned in our institution to primary angioplasty (109 patients) or systemic thrombolysis with accelerated t-PA (111 patients) within the first five hours from the onset of symptoms.

RESULTS

Baseline characteristics were similar in both groups. Primary angioplasty was independently associated with a lower in-hospital mortality (2.8% vs. 10.8%, p = 0.02, adjusted odds ratio 0.23, 95% confidence interval 0.06 to 0.85). During hospitalization, patients treated by angioplasty had a lower frequency of postinfarction angina or positive stress test (11.9% vs. 25.2%, p = 0.01) and less frequently underwent percutaneous or surgical revascularization after the initial treatment (22.0% vs. 47.7%, p < 0.001) than did patients treated by t-PA. At six month follow-up, patients treated by angioplasty had a lower cumulative rate of death (4.6% vs. 11.7%, p = 0.05) and revascularization (31.2% vs. 55.9%, p < 0.001) than those treated by t-PA.

CONCLUSIONS

In centers with an experienced and readily available interventional team, primary angioplasty is superior to t-PA for the treatment of anterior AMI.

摘要

目的

本研究比较了直接血管成形术与使用t-PA进行全身溶栓在降低前壁急性心肌梗死（AMI）患者院内死亡率方面的疗效。

背景

对于直接血管成形术相对于溶栓治疗AMI的相对益处仍存在争议。

方法

在我们机构中，220例前壁AMI患者在症状发作后的前5小时内被随机分配接受直接血管成形术（109例患者）或使用加速t-PA进行全身溶栓（111例患者）。

结果

两组的基线特征相似。直接血管成形术与较低的院内死亡率独立相关（2.8%对10.8%，p = 0.02，调整后的优势比为0.23，95%置信区间为0.06至0.85）。在住院期间，接受血管成形术治疗的患者发生梗死后心绞痛或运动试验阳性的频率较低（11.9%对25.2%，p = 0.01），并且在初始治疗后接受经皮或外科血管重建术的频率也低于接受t-PA治疗的患者（22.0%对47.7%，p < 0.001）。在6个月的随访中，接受血管成形术治疗的患者的累积死亡率（4.6%对11.7%，p = 0.05）和血管重建率（31.2%对55.9%，p < 0.001）均低于接受t-PA治疗的患者。