Morgan C D, Roberts R S, Haq A, Baigrie R S, Daly P A, Gent M, Armstrong P W
Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
J Am Coll Cardiol. 1991 Jun;17(7):1451-7. doi: 10.1016/0735-1097(91)90630-r.
Infarct size, left ventricular function and infarct-related coronary artery patency were examined in 108 patients who took part in a previously reported placebo-controlled trial of recombinant tissue-type plasminogen activator (rt-PA) in acute myocardial infarction. Coronary angiography was performed 17 +/- 0.8 h after initiation of treatment in 47 patients (group A) or at 10 days in 61 patients (group B). Both groups underwent radionuclide ventriculography 3.8 +/- 0.8 h and again on day 9 after treatment and quantitative thallium scintigraphy on day 8. In group A, the infarct-related artery was patent in 53%; these patients had a smaller global (15.1 +/- 2.5% vs. 25.7 +/- 4.7%, p = 0.029) and regional (14.7 +/- 2.5% vs. 24.1 +/- 4.7%, p = 0.044) fixed thallium defect than did those with an occluded artery. Infarct regional ejection fraction improved by 10.1 +/- 2.1% between early and late studies when the infarct-related artery was patent and by 4.8 +/- 1.4% if it was occluded (p = 0.048); changes in global and noninfarct regional ejection fraction were similar irrespective of perfusion status. Infarct regional ejection fraction and fixed thallium defect were inversely related only when the infarct-related artery was occluded (r = -0.83, p less than 0.0001). In group B, 10 day patency of the infarct-related artery was 67%; there was no difference in patency by treatment assignment or in left ventricular function or infarct size between patients with and without infarct-related artery patency. There was no evidence of an effect of rt-PA therapy beyond that expressed through coronary patency alone in either group A or group B.
对108例参与先前报道的重组组织型纤溶酶原激活剂（rt-PA）治疗急性心肌梗死的安慰剂对照试验的患者，进行了梗死面积、左心室功能和梗死相关冠状动脉通畅情况的检查。47例患者（A组）在治疗开始后17±0.8小时进行冠状动脉造影，61例患者（B组）在第10天进行冠状动脉造影。两组患者在治疗后3.8±0.8小时及第9天再次进行放射性核素心室造影，并在第8天进行定量铊闪烁扫描。在A组中，梗死相关动脉通畅率为53%；与动脉闭塞的患者相比，这些患者的整体（15.1±2.5%对25.7±4.7%，p = 0.029）和局部（14.7±2.5%对24.1±4.7%，p = 0.044）固定铊缺损较小。当梗死相关动脉通畅时，梗死局部射血分数在早期和晚期研究之间提高了10.1±2.1%，如果动脉闭塞则提高了4.8±1.4%（p = 0.048）；无论灌注状态如何，整体和非梗死局部射血分数的变化相似。仅当梗死相关动脉闭塞时，梗死局部射血分数与固定铊缺损呈负相关（r = -0.83，p＜0.0001）。在B组中，梗死相关动脉第10天的通畅率为67%；梗死相关动脉通畅与不通畅的患者在治疗分组的通畅情况、左心室功能或梗死面积方面没有差异。在A组或B组中，均没有证据表明rt-PA治疗的效果超出了仅通过冠状动脉通畅所表现出的效果。
