Relik-van Wely L, Visser R F, van der Pol J M, Bartholomeus I, Couvée J E, Drost H, Vet A J, Klomps H C, van Ekelen W A, van den Berg F
Department of Cardiology, Deaconesses Hospital, Eindhoven, The Netherlands.
Am J Cardiol. 1991 Aug 1;68(4):296-300. doi: 10.1016/0002-9149(91)90822-3.
In this open multicenter study, 156 patients with acute myocardial infarction received 30 U of anistreplase intravenously over 5 minutes within 4 hours of the onset of chest pain. The patency of the infarct-related vessel was determined by coronary angiography 90 minutes after anistreplase treatment, and also 24 hours after treatment, in patients with a patent infarct-related vessel at 90 minutes, to assess the reocclusion rate. The investigators categorized the infarct-related vessel as patent or occluded, and 2 independent cardiologists graded the infarct-related vessel according to the Thrombolysis in Myocardial Infarction (TIMI) perfusion criteria. At the 90-minute assessment, 106 of 145 evaluable patients (73%) had patent infarct-related vessels, and 39 of 145 (27%) had occluded infarct-related vessels. Of the 139 independently assessed patients, 98 (71%) had TIMI grades 2 or 3 and 41 (29%) had TIMI grades 0 or 1. At the 24-hour assessment, 98 of 102 patients (96%) had a patent infarct-related vessel, and reocclusion had occurred in 4 of 102 patients (4%). Of the 94 independently assessed patients 90 (96%) had TIMI grades 2 or 3, and 4 (4%) had TIMI grades 0 or 1. The reliability of noninvasive parameters as indicators of achieved patency of the infarct-related vessel was estimated by means of correlation with patency assessed by coronary angiography. A significant correlation of 0.62 was found. The patency rate of 71 to 73% after use of anistreplase in patients with acute myocardial infarction corresponds with findings in earlier studies. The low reocclusion rate of 4% after use of anistreplase probably reflects the prolonged action of anistreplase.
在这项开放性多中心研究中，156例急性心肌梗死患者在胸痛发作4小时内于5分钟内静脉注射30万单位茴酰化纤溶酶原链激酶激活剂复合物（anistreplase）。在茴酰化纤溶酶原链激酶激活剂复合物治疗90分钟后，通过冠状动脉造影确定梗死相关血管的通畅情况，对于90分钟时梗死相关血管通畅的患者，在治疗24小时后也进行评估，以评估再闭塞率。研究者将梗死相关血管分为通畅或闭塞，并由2名独立的心脏病专家根据心肌梗死溶栓（TIMI）灌注标准对梗死相关血管进行分级。在90分钟评估时，145例可评估患者中有106例（73%）梗死相关血管通畅，145例中有39例（27%）梗死相关血管闭塞。在139例独立评估的患者中，98例（71%）TIMI分级为2级或3级，41例（29%）TIMI分级为0级或1级。在24小时评估时，102例患者中有98例（96%）梗死相关血管通畅，102例患者中有4例（4%）发生再闭塞。在94例独立评估的患者中，90例（96%）TIMI分级为2级或3级，4例（4%）TIMI分级为0级或1级。通过与冠状动脉造影评估的通畅情况进行相关性分析，估计了作为梗死相关血管通畅指标的无创参数的可靠性。发现显著相关性为0.62。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后的通畅率为71%至73%，与早期研究结果相符。使用茴酰化纤溶酶原链激酶激活剂复合物后4%的低再闭塞率可能反映了茴酰化纤溶酶原链激酶激活剂复合物的长效作用。
