University of Ottawa Heart Institute, Canada.
Can J Cardiol. 2010 Jan;26(1):e7-12. doi: 10.1016/s0828-282x(10)70331-7.
Compared with fibrinolysis alone, fibrinolysis followed by immediate percutaneous coronary intervention (PCI) reduced clinical events in the Combined Angioplasty and Pharmacological Intervention versus Thrombolysis ALone in Acute Myocardial Infarction (CAPITAL AMI) study. It is unclear whether the benefits go beyond achieving epicardial reperfusion.
To determine the differences in ST segment resolution (STR) among patients treated with tenecteplase (TNK)-facilitated PCI compared with patients treated with TNK alone.
A formal ST segment analysis was conducted on the 170 patients with ST elevation myocardial infarction in the CAPITAL AMI trial: 86 patients treated with TNK-facilitated PCI were compared with 84 patients who were treated with TNK alone. Epicardial flow measured by percentage with Thrombolysis In Myocardial Infarction (TIMI) 3 flow improved from 52% (pre-PCI) to 89% (post-PCI) in those assigned to facilitated PCI. ST segment resolution was stratified by complete (70% or greater), partial (less than 70% to 30%) or no (less than 30% to 0%) resolution. The baseline mean ST segment elevation was 11.3+/-7.5 mm in the facilitated PCI patients and 11.8+/-7.1 mm in patients with TNK alone (P=0.66). Complete STR in the facilitated PCI patients versus the TNK-alone patients was present in 55.6% versus 54.6%, respectively (P=0.58) at 180 min and 62.0% versus 55.3% (P=0.64), respectively at day 1. The mean STR at 180 min and day 1 were similar in patients who experienced death, reinfarction, recurrent unstable ischemia or stroke at six months compared with patients who remained event free: 56.3% versus 64.6% at 180 min (P=0.40); and 67.7% versus 67.6% at day 1 (P=0.99), respectively.
TNK-facilitated PCI did not demonstrate differences in ST segment resolution compared with TNK alone, despite improvement in epicardial flow after PCI. Further studies are required to clarify these findings.
与单独溶栓相比，纤溶联合即刻经皮冠状动脉介入治疗（PCI）可降低急性心肌梗死的联合血管成形术和药物干预与单独溶栓治疗（CAPITAL AMI）研究中的临床事件发生率。尚不清楚这些益处是否超越了心外膜再灌注的实现。
确定与单独使用替奈普酶（TNK）相比，接受 TNK 辅助 PCI 治疗的患者与接受 TNK 单独治疗的患者之间 ST 段缓解（STR）的差异。
对 CAPITAL AMI 试验中 170 例 ST 段抬高型心肌梗死患者进行了正式的 ST 段分析：86 例接受 TNK 辅助 PCI 治疗的患者与 84 例接受 TNK 单独治疗的患者进行了比较。通过心肌梗死溶栓（TIMI）血流 3 级的百分比测量，接受辅助 PCI 治疗的患者的心外膜血流从 PCI 前的 52%（术前）改善至 89%（术后）。STR 按完全缓解（70%或更高）、部分缓解（低于 70%至 30%）或无缓解（低于 30%至 0%）进行分层。在接受辅助 PCI 治疗的患者中，基线平均 ST 段抬高为 11.3+/-7.5mm，而单独接受 TNK 治疗的患者为 11.8+/-7.1mm（P=0.66）。接受辅助 PCI 治疗的患者与单独接受 TNK 治疗的患者相比，在 180 分钟时完全 STR 分别为 55.6%和 54.6%（P=0.58），在第 1 天分别为 62.0%和 55.3%（P=0.64）。与无事件发生的患者相比，在 6 个月时发生死亡、再梗死、复发性不稳定缺血或卒中等事件的患者在 180 分钟和第 1 天的平均 STR 相似：180 分钟时分别为 56.3%和 64.6%（P=0.40）；第 1 天分别为 67.7%和 67.6%（P=0.99）。
尽管 PCI 后心外膜血流得到改善，但与单独使用 TNK 相比，TNK 辅助 PCI 并未显示出 ST 段缓解方面的差异。需要进一步的研究来阐明这些发现。
