Scheller Bruno, Hennen Benno, Hammer Bernd, Walle Jürgen, Hofer Christian, Hilpert Volker, Winter Horst, Nickenig Georg, Böhm Michael
Innere Medizin III, Universität des Saarlandes, Homburg/Saar, Germany.
J Am Coll Cardiol. 2003 Aug 20;42(4):634-41. doi: 10.1016/s0735-1097(03)00763-0.
The Southwest German Interventional Study in Acute Myocardial Infarction (SIAM III) investigated potentially beneficial effects of immediate stenting after thrombolysis as opposed to a more conservative treatment regimen.
Treatment of acute myocardial infarction (AMI) by thrombolysis is compromised by Thrombolysis In Myocardial Infarction (TIMI) 3 flow rates of only 60% and high re-occlusion rates of the infarct-related artery (IRA). Older studies showed no benefit of coronary angioplasty after thrombolysis compared with thrombolytic therapy alone. This observation has been challenged by the superiority of primary stenting over balloon angioplasty in AMI.
The SIAM III study was a multicenter, randomized, prospective, controlled trial in patients receiving thrombolysis in AMI (<12 h). Patients of group I were transferred within 6 h after thrombolysis for coronary angiography, including stenting of the IRA. Group II received elective coronary angiography two weeks after thrombolysis with stenting of the IRA.
A total of 197 patients were randomized, 163 patients fulfilled the secondary (angiographic) inclusion criteria (82 in group I, 81 in group II). Immediate stenting was associated with a significant reduction of the combined end point after six months (ischemic events, death, reinfarction, target lesion revascularization 25.6% vs. 50.6%, p = 0.001).
Immediate stenting after thrombolysis leads to a significant reduction of cardiac events compared with a more conservative approach including delayed stenting after two weeks.
德国西南部急性心肌梗死介入研究（SIAM III）探讨了溶栓后立即进行支架置入术相对于更保守治疗方案的潜在益处。
溶栓治疗急性心肌梗死（AMI）时，心肌梗死溶栓试验（TIMI）3级血流率仅为60%，梗死相关动脉（IRA）再闭塞率高，影响了溶栓治疗效果。早期研究表明，与单纯溶栓治疗相比，溶栓后进行冠状动脉成形术并无益处。急性心肌梗死中直接支架置入术优于球囊血管成形术，这一观察结果对上述观点提出了挑战。
SIAM III研究是一项针对急性心肌梗死（<12小时）接受溶栓治疗患者的多中心、随机、前瞻性对照试验。第一组患者在溶栓后6小时内转至导管室进行冠状动脉造影，包括对IRA进行支架置入。第二组患者在溶栓两周后接受选择性冠状动脉造影并对IRA进行支架置入。
共有197例患者被随机分组，163例患者符合二级（血管造影）纳入标准（第一组82例，第二组81例）。六个月时，立即支架置入术与联合终点事件显著减少相关（缺血事件、死亡、再梗死、靶病变血管重建25.6% 对50.6%，p = 0.001）。
与包括两周后延迟支架置入术在内的更保守方法相比，溶栓后立即进行支架置入术可显著减少心脏事件。
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