[急性心肌梗死患者接受直接血管成形术或溶栓治疗的长期随访。MITRA试验结果]

[Long-term follow-up of patients with acute myocardial infarction treated with primary angioplasty or thrombolysis. Results of the MITRA trial].

作者信息

Zhan R, Schiele R, Schneider S, Gitt A K, Heer T, Wienbergen H, Seidl K, Glunz H G, Hauptmann K E, Voigtländer T, Gottwik M, Senges J

机构信息

Herzzentrum Ludwigshafen, Kardiologie Bremserstrasse 79 67063 Ludwigshafen, Germany.

出版信息

Z Kardiol. 2002 Jan;91(1):49-57. doi: 10.1007/s392-002-8371-x.

DOI:10.1007/s392-002-8371-x

PMID:11963207

Abstract

Long-term follow-up after treatment with primary angioplasty compared to treatment with thrombolysis in patients with acute myocardial infarction (AMI) remains still to be determined. We therefore analyzed the data of the "Maximal Individual Therapy" in Acute Myocardial Infarction (MITRA-1) Registry. Follow-up data for a median of 17 months after discharge were available in 2090 out of 2195 (95%) AMI patients treated with thrombolysis, as well as 293 out of 312 patients (94%) treated with primary angioplasty. There were only small differences in patient characteristics between the two treatment groups. Compared to patients treated with thrombolysis, those treated with primary angioplasty had a higher prevalence of prior myocardial infarction (16.4% versus 12.2%, p = 0.04), longer prehospital delay: 10 minutes (130 minutes versus 120 minutes, p = 0.002), and a longer door-to-treatment time: 45 minutes (p < 0.001). Primary angioplasty patients were more likely to be treated with beta-blockers (primary angioplasty 79.8% versus thrombolysis 66.2%, p < 0.001) or statins (24.5% versus 16.5%, p < 0.001). There was no difference between the treatment groups for total mortality (p = 0.90) nor for the combined endpoint of death or re-infarction (p = 0.85). However, the combined endpoint of death, re-infarction or percutaneous coronary intervention or coronary bypass surgery was significantly lower in the primary angioplasty group (primary angioplasty 25.6% versus thrombolysis 32.3%, univariate odds ratio 0.72, 95% CI: 0.55-0.95, p = 0.02). This result was confirmed by multivariate analysis after adjusting for confounding parameters (multivariate odds ratio: 0.62, 95% CI: 0.42-0.91). The beneficial effect of primary angioplasty compared to thrombolysis achieved during the hospital stay after an AMI is maintained during a 17 month follow-up. AMI patients treated with thrombolysis were more likely to be treated with either percutaneous coronary intervention or coronary bypass surgery after discharge.

摘要

与急性心肌梗死（AMI）患者接受溶栓治疗相比，接受直接血管成形术治疗后的长期随访情况仍有待确定。因此，我们分析了急性心肌梗死“最大个体化治疗”（MITRA-1）注册研究的数据。在接受溶栓治疗的2195例AMI患者中，有2090例（95%）在出院后中位随访17个月时获得了随访数据；在接受直接血管成形术治疗的312例患者中，有293例（94%）获得了随访数据。两个治疗组的患者特征仅有微小差异。与接受溶栓治疗的患者相比，接受直接血管成形术治疗的患者既往心肌梗死的患病率更高（16.4%对12.2%，p = 0.04），院前延迟时间更长：10分钟（130分钟对120分钟，p = 0.002），且门到治疗时间更长：45分钟（p < 0.001）。接受直接血管成形术治疗的患者更有可能接受β受体阻滞剂治疗（直接血管成形术组为79.8%，溶栓组为66.2%，p < 0.001）或他汀类药物治疗（24.5%对16.5%，p < 0.001）。两个治疗组在总死亡率（p = 0.90）以及死亡或再梗死的联合终点方面没有差异（p = 0.85）。然而，直接血管成形术组在死亡、再梗死或经皮冠状动脉介入治疗或冠状动脉搭桥手术的联合终点方面显著更低（直接血管成形术组为25.6%，溶栓组为32.3%，单因素比值比为0.72，95%可信区间：0.55 - 0.95，p = 0.02）。在对混杂参数进行调整后的多因素分析证实了这一结果（多因素比值比：0.62，95%可信区间：0.42 - 0.91）。与溶栓治疗相比，直接血管成形术在AMI住院期间所取得的有益效果在17个月的随访期内得以维持。接受溶栓治疗的AMI患者出院后更有可能接受经皮冠状动脉介入治疗或冠状动脉搭桥手术。