Vrachatis A D, Alpert M A, Georgulas V P, Nikas D J, Petropoulou E N, Lazaros G I, Michelakakis N A, Karavidis A I, Lakoumentas J A, Stergiou L, Zacharoulis A A
Department of Cardiology, Athens General Hospital, Greece.
Angiology. 2001 Mar;52(3):161-6. doi: 10.1177/000331970105200301.
Following thrombolysis and primary percutaneous transluminal coronary angioplasty (PTCA) for acute ST segment elevation myocardial infarction, basal flow in the culprit artery is known to influence prognosis. The purpose of this study was to determine if differences exist in basal flow in culprit and nonculprit coronary arteries in patients with acute ST segment elevation myocardial infarction who were treated with thrombolysis or primary PTCA with stent implantation. Twenty patients were randomized to thrombolysis (with recombinant tissue plasminogen activator) and 24 to primary PTCA with stent implantation within 3 hours of onset of acute ST segment elevation myocardial infarction. Coronary angiography was performed 90-120 minutes after thrombolysis or immediately after PTCA with stent implantation and again at 18-36 hours after intervention in both groups. Patients who failed to achieve thrombolysis in myocardial infarction (TIMI) grade 2 or 3 flow were excluded. The corrected TIMI frame count was used as the index of basal coronary artery flow. Early after intervention the mean corrected TIMI frame count in the culprit coronary artery was significantly lower in the primary PTCA with stent group (27.4 +/- 7.7 frames) than in the thrombolysis group (39.8 +/- 10 frames, p < 0.001). Eight thrombolysis patients (40%) and 20 primary PTCA patients (83%, p < 0.01) achieved TIMI grade 3 flow early after intervention. By 18-36 hours after intervention there were no significant differences in the mean correct TIMI frame count between the thrombolysis and primary PTCA with stent groups. There were no significant differences in the mean corrected TIMI frame count between these two groups in the nonculprit coronary artery, either early after intervention or at 18-36 hours. In successfully reperfused coronary arteries following acute ST segment elevation myocardial infarction, primary angioplasty with stent implantation reestablished TIMI grade 2 or 3 flow faster and more effectively than thrombolysis did.
对于急性ST段抬高型心肌梗死患者，在进行溶栓及直接经皮冠状动脉腔内血管成形术（PTCA）后，已知罪犯血管的基础血流会影响预后。本研究的目的是确定接受溶栓治疗或直接PTCA并植入支架的急性ST段抬高型心肌梗死患者，其罪犯冠状动脉和非罪犯冠状动脉的基础血流是否存在差异。20例患者被随机分配接受溶栓治疗（使用重组组织型纤溶酶原激活剂），24例患者在急性ST段抬高型心肌梗死发作3小时内接受直接PTCA并植入支架。溶栓治疗后90 - 120分钟或直接PTCA并植入支架后立即进行冠状动脉造影，两组均在干预后18 - 36小时再次进行冠状动脉造影。未达到心肌梗死溶栓（TIMI）2级或3级血流的患者被排除。校正后的TIMI帧数用作冠状动脉基础血流的指标。干预后早期，直接PTCA并植入支架组罪犯冠状动脉的平均校正TIMI帧数（27.4±7.7帧）显著低于溶栓组（39.8±10帧，p<0.001）。8例溶栓患者（40%）和20例直接PTCA患者（83%，p<0.01）在干预后早期达到TIMI 3级血流。干预后18 - 36小时，溶栓组和直接PTCA并植入支架组的平均校正TIMI帧数无显著差异。在非罪犯冠状动脉中，干预后早期及18 - 36小时，两组的平均校正TIMI帧数也无显著差异。在急性ST段抬高型心肌梗死成功再灌注的冠状动脉中，直接血管成形术并植入支架比溶栓更快、更有效地重建了TIMI 2级或3级血流。
