Denktas Ali E, Athar Haris, Henry Timothy D, Larson David M, Simons Michael, Chan Roger S, Niles Nathaniel W, Thiele Holger, Schuler Gerhard, Ahn Chul, Sdringola Stefano, Anderson H Vernon, McKay Raymond G, Smalling Richard W
University of Texas Medical School and Memorial Hermann Heart and Vascular Institute, Houston, USA.
JACC Cardiovasc Interv. 2008 Oct;1(5):504-10. doi: 10.1016/j.jcin.2008.06.009.
We sought to evaluate the impact of a strategy of reduced-dose fibrinolytic acceleration of ST-segment elevation myocardial infarction (STEMI) treatment followed by urgent percutaneous coronary intervention (FAST-PCI) on the mortality, reinfarction, and stroke rates in STEMI patients as compared with a primary percutaneous coronary intervention (PPCI) approach.
Time to reperfusion is a major determinant of mortality among STEMI patients. Rapid initiation of fibrinolytic therapy can shorten time to reperfusion, and mechanical therapy of the culprit lesion is known to be beneficial.
Data from 2,869 STEMI patients treated in 5 high-volume percutaneous coronary intervention (PCI) centers were pooled for analysis. Mortality at 30 days was the primary end point. Death, reinfarction, and stroke were secondary end points, as were infarct-related artery TIMI (Thrombolysis In Myocardial Infarction) flow grade before PCI and shock on arrival to the catheterization laboratory.
Compared to PPCI, mortality at 30 days was significantly lower with FAST-PCI (3.8% vs. 6.4%, p = 0.002). The combined triple end point of death, reinfarction, or stroke was also less frequent (5.1% vs. 8.9%, p < 0.0001). The FAST-PCI patients had a lower incidence of Killip class IV (5.6% vs. 10.9%, p < 0.0001) and higher infarct-related artery TIMI flow grades (2.1 +/- 1.2 vs. 1.1 +/- 1.3, p < 0.0001) upon arrival in the catheterization laboratory. Stepwise logistic regression analysis demonstrated that FAST-PCI was an independent predictor of 30-day mortality (relative risk = 0.542, p = 0.0151).
The FAST-PCI strategy reduced the mortality and combined end point of death, reinfarction, and stroke among STEMI patients, without increasing the risk of stroke or bleeding, compared to PPCI. Fibrinolysis before hospital admission also increased the initial infarct-related artery patency and decreased the likelihood of shock at presentation.
我们试图评估与直接经皮冠状动脉介入治疗（PPCI）方法相比，采用小剂量纤溶加速策略治疗ST段抬高型心肌梗死（STEMI）并随后进行紧急经皮冠状动脉介入治疗（FAST-PCI）对STEMI患者死亡率、再梗死率和卒中率的影响。
再灌注时间是STEMI患者死亡率的主要决定因素。快速启动纤溶治疗可缩短再灌注时间，且已知对罪犯病变进行机械治疗有益。
汇总了5家高容量经皮冠状动脉介入治疗（PCI）中心治疗的2869例STEMI患者的数据进行分析。30天死亡率是主要终点。死亡、再梗死和卒中是次要终点，PCI前梗死相关动脉TIMI（心肌梗死溶栓）血流分级以及到达导管室时的休克情况也是次要终点。
与PPCI相比，FAST-PCI的30天死亡率显著更低（3.8%对6.4%，p = 0.002）。死亡、再梗死或卒中的联合三终点也更少见（5.1%对8.9%，p < 0.0001）。FAST-PCI患者到达导管室时Killip IV级的发生率更低（5.6%对10.9%，p < 0.0001），梗死相关动脉TIMI血流分级更高（2.1±1.2对1.1±1.3，p < 0.0001）。逐步逻辑回归分析表明，FAST-PCI是30天死亡率的独立预测因素（相对风险 = 0.542，p = 0.0151）。
与PPCI相比，FAST-PCI策略降低了STEMI患者的死亡率以及死亡、再梗死和卒中的联合终点，且未增加卒中或出血风险。入院前进行纤溶治疗还提高了初始梗死相关动脉的通畅率，并降低了就诊时休克的可能性。
