El-Menyar Ayman A, Altamimi Omar M, Gomaa Mohamed M, Dabdoob Wafer, Abbas Ali A, Abdel Rahman Mohammed O, Bener Abdulbari, Albinali Hajar A
Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Hamad General Hospital, Doha, State of Qatar.
Coron Artery Dis. 2006 Aug;17(5):431-7. doi: 10.1097/00019501-200608000-00006.
The presence of plasminogen activator inhibitor-1, angiotensin-converting enzyme and others may play a role in unsuccessful recanalization after thrombolytic therapy.
To find out the clinical and biochemical predictors that may affect the choice and short-term outcomes following different thrombolytic agents in acute myocardial infarction.
Angiotensin-converting enzyme and plasminogen activator inhibitor-1 plasma levels of 184 patients with acute myocardial infarction, treated with streptokinase, metalyze or reteplase, were determined. Failure of thrombolysis was assessed by noninvasive reperfusion criteria. Prolonged hospitalization, impaired left ventricular ejection fraction and reinfarction were considered as short-term outcomes.
Patients who received streptokinase developed higher incidence of >50% resolution of ST-segment elevation (82.5 vs. 64.7%, P-value<0.05, in comparison with metalyze and 82.5 vs. 55.7%, P-value 0.001, in comparison with reteplase) than those who received other thrombolytic agents. High plasma angiotensin-converting enzyme was associated with prolonged hospitalization (55, 63 and 94%, P<0.02) following streptokinase, metalyze and reteplase, respectively. High plasma plasminogen activator inhibitor-1 is associated with impaired left ventricular ejection fraction (55.3, 76.7 and 68.5%, P<0.09), ST resolution<50% (13.2, 36.7 and 37.5%, P=0.03), ST resolution>50% (86.8, 63.3 and 62.5%, P=0.03) following streptokinase, metalyze and reteplase, respectively.
Rapid determination of pretreatment angiotensin-converting enzyme and plasminogen activator inhibitor-1 plasma levels in patients with acute myocardial infarction may influence the choice and outcomes of the thrombolytic agents. The presence of a high plasma level of either angiotensin-converting enzyme or plasminogen activator inhibitor-1 is significantly associated with adverse short-term outcomes after treatment with reteplase or metalyze.
纤溶酶原激活物抑制剂-1、血管紧张素转换酶及其他物质的存在可能在溶栓治疗后再通失败中起作用。
找出可能影响急性心肌梗死患者使用不同溶栓药物后的选择及短期预后的临床和生化预测指标。
测定了184例接受链激酶、替奈普酶或瑞替普酶治疗的急性心肌梗死患者的血管紧张素转换酶和纤溶酶原激活物抑制剂-1血浆水平。通过无创再灌注标准评估溶栓失败情况。延长住院时间、左心室射血分数受损及再梗死被视为短期预后指标。
与接受其他溶栓药物的患者相比，接受链激酶治疗的患者ST段抬高>50%消退的发生率更高（与替奈普酶相比为82.5%对64.7%，P值<0.05；与瑞替普酶相比为82.5%对55.7%，P值0.001）。血浆血管紧张素转换酶水平高分别与链激酶、替奈普酶和瑞替普酶治疗后延长住院时间相关（分别为55%、63%和94%，P<0.02）。血浆纤溶酶原激活物抑制剂-1水平高分别与链激酶、替奈普酶和瑞替普酶治疗后左心室射血分数受损（分别为55.3%、76.7%和68.5%，P<0.09）、ST段消退<50%（分别为13.2%、36.7%和37.5%，P=0.03）、ST段消退>50%（分别为86.8%、63.3%和62.5%，P=0.03）相关。
快速测定急性心肌梗死患者治疗前血管紧张素转换酶和纤溶酶原激活物抑制剂-1血浆水平可能会影响溶栓药物的选择和预后。血管紧张素转换酶或纤溶酶原激活物抑制剂-1血浆水平高与瑞替普酶或替奈普酶治疗后的不良短期预后显著相关。
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