Schröder R, Zeymer U, Wegscheider K, Neuhaus K L
The Co-ordinating Centre of the HIT-4 Trial, Kassel and Berlin, Germany.
Eur Heart J. 1999 Nov;20(21):1563-71. doi: 10.1053/euhj.1999.1664.
Previous studies revealed that >/=70% or <30% ST segment elevation resolution 180 min after the start of thrombolysis is a strong predictor of either favourable or poor outcome. The aim of this study was to compare the prognostic value of ST segment elevation resolution at 90 and 180 min after the start of streptokinase infusion.
The Hirudin for Improvement of Thrombolysis (HIT)-4 study of 1208 patients compared streptokinase therapy in conjunction with either r-hirudin or heparin. Complete ST segment elevation resolution (>/=70%) at 90 and 180 min identified 25% and 50%, respectively, of all patients with a 30 day cardiac mortality of less than 2%. Forty-four percent of patients had no ST segment elevation resolution (<30%) at 90 min and the 30 day cardiac mortality was 7.3%. At 180 min, the no ST segment elevation resolution group decreased to 15% of all patients while the mortality risk increased to 13.6%.
ST segment elevation resolution is a useful tool for early risk stratification and the strategy of rescue angioplasty. Complete ST segment elevation resolution within 180 min of the start of streptokinase therapy indicates excellent survival prospects in 50% of patients. A half of these low risk patients can be identified at 90 min. A high risk group appears to be best characterized by no ST segment elevation resolution at 180 min rather than at 90 min.
既往研究表明，溶栓开始180分钟后ST段抬高分辨率≥70%或＜30%是预后良好或不良的有力预测指标。本研究旨在比较链激酶输注开始后90分钟和180分钟时ST段抬高分辨率的预后价值。
1208例患者参与的水蛭素改善溶栓（HIT）-4研究比较了链激酶联合重组水蛭素或肝素的治疗效果。90分钟和180分钟时ST段抬高完全分辨率（≥70%）分别确定了所有30天心脏死亡率低于2%患者中的25%和50%。44%的患者在90分钟时ST段抬高无分辨率（＜30%），30天心脏死亡率为7.3%。在180分钟时，ST段抬高无分辨率组降至所有患者的15%，而死亡风险增加至13.6%。
ST段抬高分辨率是早期风险分层和补救性血管成形术策略的有用工具。链激酶治疗开始180分钟内ST段抬高完全分辨率表明50%的患者有良好的生存前景。这些低风险患者中有一半可在90分钟时识别出来。高风险组似乎最好以180分钟而非90分钟时ST段抬高无分辨率为特征。
