Zaputović L, Mavrić Z, Mlinarić B, Kupanovac Z, Matana A, Marinović D
Department of Internal Medicine, University Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia.
Croat Med J. 2000 Dec;41(4):401-5.
To investigate the eligibility of patients with acute myocardial infarction (AMI) for thrombolytic therapy (TT) and evaluate the results of treatment.
Retrospective analysis included 366 patients with AMI, mean age 66+/-11 years, treated in 1999. We analyzed age, gender, previous infarction, previous TT, present TT with streptokinase and its effects on the course and outcome, pain-to-door time, and door-to-needle time. Reperfusion and reocclusion were evaluated non-invasively according to the occurrence of the reperfusion and reocclusion syndrome.
One hundred patients (27%) underwent TT. It was less frequently applied in older patients, women, and patients with previous myocardial infarction. Reperfusion was achieved in 66 (66%) patients and reocclusion occurred in 9 (14%). Final outcome was successful in 57 (57%) patients. The TT group had more frequent arrhythmias (67% vs. 41%, p<0.001) and less frequent heart failure (20% vs. 39%, p<0.001) than the patients without TT. The mortality after TT was significantly lower (7% vs. 17%, p=0.015), without fatal outcome in patients with finally successful TT. Reasons against TT application were late arrival to hospital (51%) and contraindications for TT (34%). In patients without TT, the median pain-to-door time and door-to-needle time were significantly longer than in the TT group (7 vs. 2.5 hours and 55 vs. 20 min, respectively; p<0.001).
Older age, female gender, previous myocardial infarction, and late arrival to the CCU negatively influence the use of TT in AMI. TT should be improved by shortening pain-to-door time, broadening indications, and limiting contraindications.
研究急性心肌梗死（AMI）患者进行溶栓治疗（TT）的适宜性并评估治疗结果。
回顾性分析1999年治疗的366例AMI患者，平均年龄66±11岁。我们分析了年龄、性别、既往梗死史、既往TT史、当前使用链激酶进行的TT及其对病程和结局的影响、疼痛至入院时间以及入院至穿刺时间。根据再灌注和再闭塞综合征的发生情况对再灌注和再闭塞进行无创评估。
100例患者（27%）接受了TT。在老年患者、女性患者和既往有心肌梗死的患者中应用频率较低。66例（66%）患者实现了再灌注，9例（14%）发生了再闭塞。57例（57%）患者最终结局成功。与未接受TT的患者相比，TT组心律失常更常见（67%对41%，p<0.001），心力衰竭更少见（20%对39%，p<0.001）。TT后的死亡率显著更低（7%对17%，p=0.015），最终TT成功的患者无死亡结局。不应用TT的原因是入院晚（51%）和TT的禁忌证（34%）。在未接受TT的患者中，疼痛至入院时间和入院至穿刺时间的中位数显著长于TT组（分别为7小时对2.5小时和55分钟对20分钟；p<0.001）。
高龄、女性、既往心肌梗死以及入住冠心病监护病房晚对AMI患者TT的使用产生负面影响。应通过缩短疼痛至入院时间、扩大适应证和限制禁忌证来改进TT。
