Schömig Albert, Ndrepepa Gjin, Mehilli Julinda, Schwaiger Markus, Schühlen Helmut, Nekolla Stephan, Pache Jürgen, Martinoff Stefan, Bollwein Hildegard, Kastrati Adnan
Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, München, Germany.
Circulation. 2003 Sep 2;108(9):1084-8. doi: 10.1161/01.CIR.0000086346.32856.9C. Epub 2003 Aug 18.
The relationship between myocardial salvage and time-to-treatment interval in patients with acute myocardial infarction (AMI) treated with coronary artery stenting or thrombolysis has not been studied.
This study analyzed 264 patients with AMI randomized to coronary stenting (133 patients) or thrombolysis (131 patients) in the setting of 2 randomized trials. Patients were divided into the following 3 groups defined by tertiles of the time-to-treatment interval: lower tertile (<165 minutes), middle tertile (165 to 280 minutes), and upper tertile (>280 minutes). Paired scintigraphic examinations were performed to obtain salvage index, which was the primary end point of the study. In the group with thrombolysis, the salvage index (median [25th; 75th] percentile) was 0.45 (0.16; 0.83) in the lower, 0.29 (0.17; 0.48) in the middle, and 0.20 (0.04; 0.46) in the upper tertile (P=0.03). In the group with stenting, the salvage index was 0.56 (0.49; 0.75) in the lower, 0.57 (0.36; 0.73) in the middle, and 0.57 (0.32; 0.75) in the upper tertile (P=0.59). In patients treated with stenting, the salvage index was greater than in patients treated with thrombolysis in the lower (0.56 versus 0.45, P=0.09), middle (0.57 versus 0.29, P=0.0003), and upper (0.57 versus 0.20, P=0.0005) tertiles of the time-to-treatment interval.
The influence of the time-to-treatment interval on the myocardial salvage in patients with AMI depends on the type of reperfusion therapy. Coronary artery stenting was superior to thrombolysis independent of the time-to-treatment intervals, and the difference in benefit increased with more prolonged time from symptom onset.
尚未研究接受冠状动脉支架置入术或溶栓治疗的急性心肌梗死（AMI）患者心肌挽救与治疗时间间隔之间的关系。
本研究在2项随机试验中分析了264例随机接受冠状动脉支架置入术（133例患者）或溶栓治疗（131例患者）的AMI患者。根据治疗时间间隔的三分位数将患者分为以下3组：低三分位数组（<165分钟）、中三分位数组（165至280分钟）和高三分位数组（>280分钟）。进行配对闪烁显像检查以获得挽救指数，这是本研究的主要终点。在溶栓治疗组中，低三分位数组的挽救指数（中位数[第25；第75]百分位数）为0.45（0.16；0.83），中三分位数组为0.29（0.17；0.48），高三分位数组为0.20（0.04；0.46）（P=0.03）。在支架置入术组中，低三分位数组的挽救指数为0.56（0.49；0.75），中三分位数组为0.57（0.36；0.73），高三分位数组为0.57（0.32；0.75）（P=0.59）。在接受支架置入术治疗的患者中，在治疗时间间隔的低三分位数组（0.56对0.45，P=0.09）、中三分位数组（0.57对0.29，P=0.0003）和高三分位数组（0.57对0.20，P=0.0005）中，挽救指数均高于接受溶栓治疗的患者。
治疗时间间隔对AMI患者心肌挽救的影响取决于再灌注治疗的类型。冠状动脉支架置入术优于溶栓治疗，且与治疗时间间隔无关，症状发作后时间越长，获益差异越大。
