Hackett D, Andreotti F, Haider A W, Brunelli C, Shahi M, Fussell A, Buller N, Foale R, Lipkin D, Caponnetto S
Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, United Kingdom.
Am J Cardiol. 1992 Jun 1;69(17):1393-8. doi: 10.1016/0002-9149(92)90888-6.
The efficacy of multiple intravenous bolus injections of tissue-type plasminogen activator (t-PA) in inducing rapid coronary recanalization in patients with acute myocardial infarction was previously demonstrated. In this Bolus Dose-Escalation Study of Tissue-Type Plasminogen Activator (BEST), the efficacy of 3 different doses of a single rapid intravenous bolus injection of t-PA (dute-plase, Wellcome Foundation, London) in inducing coronary patency (Thrombolysis In Myocardial Infarction perfusion grade 2 or 3) in 64 patients with acute myocardial infarction presenting less than 6 hours after onset of symptoms was investigated. At 60 minutes after administration of t-PA, the infarct-related coronary artery was patent in 9 of 17 patients (53%; 95% confidence interval [CI] 28 to 77%) after 0.3 MU/kg, in 14 of 23 (61%; 95% CI 39 to 80%) after 0.45 MU/kg and in 10 of 14 (71%; 95% CI 42 to 92%) after 0.6 MU/kg. At 90 minutes after t-PA, coronary patency was present in 9 of 17 cases (53%; 95% CI 28 to 77%) after 0.3 MU/kg, in 12 of 24 (50%; 95% CI 29 to 71%) after 0.45 MU/kg and in 10 of 13 (77%; 95% CI 46 to 95%) after 0.6 MU/kg. One patient in each dose group had a silent reoccluded infarct-related artery by 24 hours, and there were 2 clinical reinfarctions before discharge. No major bleeding events were observed. There were 5 hospital deaths, all unrelated to t-PA. A single intravenous bolus injection of 0.6 MU/kg of t-PA appears to be effective in inducing rapid coronary patency and to be safe in patients with acute myocardial infarction.
先前已证明，多次静脉推注组织型纤溶酶原激活剂（t-PA）对急性心肌梗死患者诱导冠状动脉快速再通有效。在这项组织型纤溶酶原激活剂推注剂量递增研究（BEST）中，研究了单次快速静脉推注3种不同剂量的t-PA（都替普酶，威康信托基金会，伦敦）对64例症状发作后不到6小时的急性心肌梗死患者诱导冠状动脉通畅（心肌梗死溶栓灌注2级或3级）的效果。在给予t-PA后60分钟，0.3MU/kg剂量组17例患者中有9例（53%；95%置信区间[CI]28%至77%）梗死相关冠状动脉通畅，0.45MU/kg剂量组23例中有14例（61%；95%CI 39%至80%）通畅，0.6MU/kg剂量组14例中有10例（71%；95%CI 42%至92%）通畅。在给予t-PA后90分钟，0.3MU/kg剂量组17例中有9例（53%；95%CI 28%至77%）冠状动脉通畅，0.45MU/kg剂量组24例中有12例（50%；95%CI 29%至71%）通畅，0.6MU/kg剂量组13例中有10例（77%；95%CI 46%至95%）通畅。各剂量组均有1例患者在24小时时梗死相关动脉无症状性再闭塞，出院前有2例临床再梗死。未观察到重大出血事件。有5例住院死亡，均与t-PA无关。单次静脉推注0.6MU/kg的t-PA似乎对诱导冠状动脉快速通畅有效，且对急性心肌梗死患者安全。
