与在最近医院进行即刻溶栓治疗相比，初级血管成形术的院间转运改善了急性心肌梗死的长期预后（PRAGUE-1研究的一年随访结果）。

Interhospital transport for primary angioplasty improves the long-term outcome of acute myocardial infarction compared with immediate thrombolysis in the nearest hospital (one-year follow-up of the PRAGUE-1 study).

作者信息

Bednár Frantisek, Widimský Petr, Krupicka Jirí, Groch Ladislav, Aschermann Michael, Zelízko Michael

机构信息

Královské Vinohrady University Hospital, Prague, Czech Republic.

出版信息

Can J Cardiol. 2003 Sep;19(10):1133-7.

PMID:14532938

Abstract

OBJECTIVE

Comparison of the long-term outcomes of three reperfusion strategies in patients with acute ST elevation myocardial infarction presenting to community hospitals.

METHODS

One-year clinical outcomes were compared for 300 patients randomized in the PRimary Angioplasty in patients transferred from General community hospitals to specialized percutaneous coronary intervention Units with or without Emergency thrombolysis (PRAGUE-1) study to one of three treatment strategies: thrombolysis in a community hospital (group A, n=99); thrombolysis during immediate transportation for coronary angioplasty (group B, n=100); and immediate transportation for coronary angioplasty without thrombolysis (group C, n=101).

RESULTS

Total mortality rates in group A, B and C patients were 18%, 12% and 13%, respectively (not significant). Nonfatal reinfarction occurred in 12%, 6% and 3% of patients, respectively (P<0.05). The combined endpoint (total mortality and nonfatal reinfarction rate) was reported in 30%, 18% and 16% of patients, respectively (P<0.05). In patients randomized within 2 h of the onset of symptoms, mortality rates were 18%, 3% and 8%, respectively (P<0.05). Additional revascularization procedures (percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery) were performed in 35%, 14% and 15% of patients, respectively (P<0.001).

CONCLUSIONS

Primary angioplasty (even if delayed due to patient transportation to an interventional centre) is associated with better short- and long-term clinical outcomes than thrombolysis. The combination of the two strategies did not prove superior to coronary angioplasty alone. However, it may be superior in a subset of patients with early admission. The coronary angioplasty strategy decreases the need for revascularization procedures during the subsequent one-year follow-up.

摘要

目的

比较在社区医院就诊的急性ST段抬高型心肌梗死患者三种再灌注策略的长期结局。

方法

对300例患者的一年临床结局进行比较，这些患者在从综合社区医院转至有或无紧急溶栓的专科经皮冠状动脉介入治疗单位的患者初级血管成形术（PRAGUE-1）研究中被随机分为三种治疗策略之一：在社区医院溶栓（A组，n = 99）；在立即转运进行冠状动脉成形术期间溶栓（B组，n = 100）；以及立即转运进行冠状动脉成形术且不溶栓（C组，n = 101）。

结果

A组、B组和C组患者的总死亡率分别为18%、12%和13%（无显著差异）。非致命性再梗死分别发生在12%、6%和3%的患者中（P<0.05）。联合终点（总死亡率和非致命性再梗死率）分别在30%、18%和16%的患者中出现（P<0.05）。在症状发作2小时内随机分组的患者中，死亡率分别为18%、3%和8%（P<0.05）。分别有35%、14%和15%的患者接受了额外的血运重建手术（经皮腔内冠状动脉成形术、冠状动脉旁路移植术）（P<0.001）。