Ellis CJ, French JK, White HD
Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
J Thromb Thrombolysis. 1997;4(2):239-250. doi: 10.1023/a:1008894901473.
Central to many of the major advances seen in the treatment of acute myocardial infarction over the last 15 years has been the concept that reperfusion by thrombolytic therapy, by producing early patency of an infarct-related artery, salvages myocardium and preserves left ventricular function. Large clinical trials have confirmed the mortality benefits of thrombolytic therapy, which has become the standard worldwide treatment. It is increasingly evident that complete reperfusion (TIMI 3 flow) is needed to achieve the optimum patient outcome. In addition, the benefits of microvascular reperfusion are now being recognized. The evaluation of new regimens and therapies to improve early patency are exciting current developments. Recently it has been shown for the first time that late patency of the infarct-related artery is an independent predictor of survival. This extension of the open-artery theory has major implications for both the treatment of acute myocardial infarction and future thrombolytic and revascularization policies for surviving patients.
在过去15年急性心肌梗死治疗中许多重大进展的核心是这样一个概念，即溶栓治疗实现再灌注，通过使梗死相关动脉早期开通，挽救心肌并保留左心室功能。大型临床试验证实了溶栓治疗的死亡率获益，其已成为全球标准治疗方法。越来越明显的是，需要实现完全再灌注（TIMI 3级血流）以获得最佳患者预后。此外，微血管再灌注的益处现在也得到了认可。评估改善早期开通的新方案和疗法是当前令人兴奋的进展。最近首次表明，梗死相关动脉的晚期开通是生存的独立预测因素。开放动脉理论的这一扩展对急性心肌梗死的治疗以及存活患者未来的溶栓和血管重建策略都具有重要意义。
