Bassand J P, Anguenot T, Cassagnes J, Lusson J R, Machecourt J, Wolf J E
Centre Hospitalier Universitaire, Besançon, France.
Am J Cardiol. 1991 Dec 5;68(16):23E-29E. doi: 10.1016/0002-9149(91)90302-2.
In recent acute myocardial infarction, early reperfusion of the infarct-related artery by intracoronary or intravenous thrombolytic therapy induces a significant limitation of infarct size, provided reperfusion occurs within a time frame that myocardial salvage can still be expected. Limitation of infarct size reduces scar tissue formation, aneurysm formation, infarct zone expansion, left ventricular volume enlargement, and eventually results in higher left ventricular ejection fraction. Infarct size limitation and left ventricular function preservation occur with all thrombolytic agents currently in clinical use: streptokinase, alteplase and, more recently, anistreplase. When anistreplase is compared with conventional heparin therapy, a 31% reduction in infarct size is found (estimated from single photon emission computed tomography, or SPECT). This translates into a significant preservation of left ventricular ejection fraction as observed in anistreplase-treated patients compared with heparin-treated patients (0.53 +/- 0.13 vs 0.47 +/- 0.12, p less than 0.002). In comparative trials of 2 thrombolytic agents, anistreplase was demonstrated to be as efficient as alteplase on left ventricular ejection fraction preservation and infarct size limitation.
在近期急性心肌梗死中，通过冠状动脉内或静脉溶栓治疗使梗死相关动脉早期再灌注，可显著限制梗死面积，前提是再灌注发生在仍可预期心肌挽救的时间范围内。梗死面积的限制可减少瘢痕组织形成、动脉瘤形成、梗死区扩展、左心室容积增大，并最终导致更高的左心室射血分数。目前临床使用的所有溶栓药物（链激酶、阿替普酶以及最近的茴酰化纤溶酶原链激酶激活剂复合物）均可实现梗死面积的限制和左心室功能的保留。当将茴酰化纤溶酶原链激酶激活剂复合物与传统肝素治疗进行比较时，发现梗死面积减少了31%（通过单光子发射计算机断层扫描或SPECT估算）。这意味着与肝素治疗的患者相比，茴酰化纤溶酶原链激酶激活剂复合物治疗的患者左心室射血分数得到了显著保留（分别为0.53±0.13和0.47±0.12，p<0.002）。在两种溶栓药物的对比试验中，茴酰化纤溶酶原链激酶激活剂复合物在保留左心室射血分数和限制梗死面积方面与阿替普酶效果相当。
