Fox K A
Cardiovascular Research Unit, University of Edinburgh, Scotland, United Kingdom.
Am J Cardiol. 1991 Dec 5;68(16):38E-44E. doi: 10.1016/0002-9149(91)90304-4.
In patients with acute myocardial infarction, thrombolytic therapy has a demonstrable and favorable impact on a range of clinical indicators, including left ventricular function, infarct size, coronary arterial patency, and symptom relief. However, these indicators have not provided a reliable basis for the comparison of thrombolytic regimens; mortality provides the "gold standard." One-year mortality obviates the differences in the timing of short-term comparisons (in-hospital, 30-day, or 5-week). In addition, late effects of differences in patency, including the impact of reocclusion, infarct healing, and remodeling, will be evident by 1 year. Meta-analysis of data from previous major mortality studies shows that differences in design and the overlap of confidence intervals of mortality studies suggest that no thrombolytic agent is superior in terms of short-term mortality. Long-term survival may provide a more meaningful basis for comparison of efficacy of the thrombolytic regimens. Long-term mortality has been evaluated for anistreplase in acute myocardial infarction in a composite analysis, similar to a meta-analysis. From the pooled life table analysis of all anistreplase studies, the odds reduction in mortality at 1 year was approximately 48%.
在急性心肌梗死患者中，溶栓治疗对一系列临床指标具有明显且有益的影响，包括左心室功能、梗死面积、冠状动脉通畅情况及症状缓解。然而，这些指标并未为溶栓方案的比较提供可靠依据；死亡率才是“金标准”。一年死亡率消除了短期比较（住院期间、30天或5周）时间点上的差异。此外，通畅情况差异的后期影响，包括再闭塞、梗死愈合和重塑的影响，到1年时将变得明显。对以往主要死亡率研究数据的荟萃分析表明，设计差异以及死亡率研究置信区间的重叠表明，就短期死亡率而言，没有哪种溶栓剂更具优势。长期生存可能为比较溶栓方案的疗效提供更有意义的依据。在一项类似于荟萃分析的综合分析中，已对急性心肌梗死患者使用茴酰化纤溶酶原链激酶激活剂复合物（anisoylated plasminogen streptokinase activator complex，APSAC）进行了长期死亡率评估。从所有APSAC研究的汇总生命表分析来看，1年时死亡率的比值降低约为48%。
