溶栓与冠状动脉闭塞：对非梗死区的影响。

Thrombolysis and coronary occlusion: effects upon the non-infarct zone.

作者信息

Cranswick R, Carter G, Wilkes N, Nelson G

机构信息

TICO Working Group, Royal North Shore Hospital, St Leonards, Sydney, Australia.

出版信息

Eur Heart J. 1992 Jun;13(6):770-5. doi: 10.1093/oxfordjournals.eurheartj.a060254.

DOI:10.1093/oxfordjournals.eurheartj.a060254

PMID:1623865

Abstract

Regional wall motion was examined by angiography after 3 weeks in 154 patients taking part in the Thrombolysis in Coronary Occlusion (TICO) Trial. Coronary patency rate was greater after administration of recombinant tissue plasminogen activator, (rt-PA 62/77pts 81%) than after a placebo (P 49/77pts 64% P = 0.02), particularly for the left anterior descending artery compared with the right coronary artery (LAD 27/28 96% vs RCA 28/40 70% P = 0.006). Left ventricular ejection fraction (LVEF) was preserved after rt-PA (rt-PA 59 +/- 14% vs P 53 +/- 15% P = 0.01), predominantly because of more effective non-infarct zone contraction (rt-PA 0.52 +/- 1.16 SD/cord vs P 1.01 +/- 1.07 SD/cord P = 0.008). Infarct zone scores differed little (rt-PA 2.88 +/- 0.95 SD/cord vs P 3.16 +/- 1.11 SD/cord P = 0.09). Left ventricular ejection fraction and non-infarct zone function were best preserved after rt-PA compared with the placebo, particularly in patients with single vessel disease and in patients in whom the infarct-related artery was the left anterior descending vessel.

摘要

154名参与冠状动脉闭塞溶栓（TICO）试验的患者在3周后通过血管造影检查局部室壁运动。给予重组组织型纤溶酶原激活剂（rt-PA，62/77例患者，81%）后的冠状动脉通畅率高于给予安慰剂后（49/77例患者，64%，P = 0.02），尤其是左前降支动脉与右冠状动脉相比（左前降支27/28，96% 对右冠状动脉28/40，70%，P = 0.006）。rt-PA治疗后左心室射血分数（LVEF）得以保留（rt-PA 59±14% 对安慰剂53±15%，P = 0.01），主要是因为非梗死区收缩更有效（rt-PA 0.52±1.16标准差/节段对安慰剂1.01±1.07标准差/节段，P = 0.008）。梗死区评分差异不大（rt-PA 2.88±0.95标准差/节段对安慰剂3.16±1.11标准差/节段，P = 0.09）。与安慰剂相比，rt-PA治疗后左心室射血分数和非梗死区功能保留最佳，尤其是在单支血管病变患者以及梗死相关动脉为左前降支血管的患者中。