French J K, Hyde T A, Patel H, Amos D J, McLaughlin S C, Webber B J, White H D
Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
J Am Coll Cardiol. 1999 Jul;34(1):62-9. doi: 10.1016/s0735-1097(99)00166-7.
The purpose of this study was to determine whether the mortality benefit of intravenous streptokinase administered within 4 h of the onset of acute myocardial infarction is maintained at 12 years, and whether Thrombolysis in Myocardial Infarction (TIMI) flow grades independently influence late survival.
Treatment with reperfusion therapies and achievement of TIMI 3 flow are associated with increased short- and medium-term survival after infarction. Whether infarct artery flow independently influences survival more than five years after infarction is unknown.
The late survival of patients randomized to receive either streptokinase (1,500,000 IU over 30 to 60 min) or a matching placebo within 4 h of symptom onset in 1984-1986 was determined. Angiography was performed in surviving patients at three to four weeks, and TIMI flow grades were assessed blind to randomization and outcomes. The late vital status was determined in 99% of patients.
Patients randomized to receive streptokinase (n = 107) had improved survival compared with those randomized to placebo (n = 112) at five years (84% vs. 70%; p = 0.023) and 12 years (66% vs. 51%; p = 0.022). At five years 94% of patients with TIMI grade 3 flow, 81% of those with TIMI grade 2 flow and 72% of those with TIMI grade 0-1 flow survived (p = 0.005). At 12 years 72% of patients with TIMI 3, 67% of those with TIMI 2 and 54% of those with TIMI 0-1 flow survived (p = 0.023). Multivariate analysis identified the ejection fraction (p = 0.014), exercise duration (p = 0.013) and TIMI 3 flow (p = 0.04 compared with TIMI 0-2 flow) as important factors for five-year survival. At 12 years multivariate predictors of late survival were the ejection fraction (p = 0.006), exercise duration (p = 0.003) and myocardial score (p = 0.013). The end-systolic volume index was similar to the ejection fraction as a predictor of survival at five and 12 years.
The survival benefits of streptokinase persist for 12 years after infarction. TIMI flow at three to four weeks is an independent predictor of five-year survival.
本研究旨在确定急性心肌梗死发病4小时内静脉注射链激酶的死亡率获益在12年后是否依然存在，以及心肌梗死溶栓（TIMI）血流分级是否独立影响晚期生存率。
再灌注治疗及实现TIMI 3级血流与梗死后期短期和中期生存率提高相关。梗死动脉血流在梗死后5年以上是否独立影响生存率尚不清楚。
对1984 - 1986年症状发作4小时内随机接受链激酶（30至60分钟内150万国际单位）或匹配安慰剂的患者的晚期生存率进行测定。在存活患者三至四周时进行血管造影，并在对随机分组和结果不知情的情况下评估TIMI血流分级。99%的患者确定了晚期生命状态。
随机接受链激酶治疗的患者（n = 107）在5年时（84%对70%；p = 0.023）和12年时（66%对51%；p = 0.022）的生存率高于随机接受安慰剂的患者（n = 112）。在5年时，TIMI 3级血流患者中有94%存活，TIMI 2级血流患者中有81%存活，TIMI 0 - 1级血流患者中有72%存活（p = 0.005）。在12年时，TIMI 3级血流患者中有72%存活，TIMI 2级血流患者中有67%存活，TIMI 0 - 1级血流患者中有54%存活（p = 0.023）。多变量分析确定射血分数（p = 0.014）、运动持续时间（p = 0.013）和TIMI 3级血流（与TIMI 0 - 2级血流相比，p = 0.04）是5年生存率的重要因素。在12年时，晚期生存的多变量预测因素是射血分数（p = 0.006）、运动持续时间（p = 0.003）和心肌评分（p = 0.013）。收缩末期容积指数与射血分数在5年和12年时作为生存预测指标相似。
链激酶的生存获益在梗死后持续12年。三至四周时的TIMI血流是5年生存率的独立预测指标。
