Gertz S D, Kragel A H, Kalan J M, Braunwald E, Roberts W C
Pathology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892.
Am J Cardiol. 1990 Oct 15;66(12):904-9. doi: 10.1016/0002-9149(90)90923-o.
The hearts of 61 patients (39 men aged 64 +/- 11 years) who died from 5 hours to 42 days (median 3 days) after a fatal first acute myocardial infarction without having undergone percutaneous transluminal coronary angioplasty or coronary bypass surgery were studied to compare clinical and cardiac morphologic features of patients receiving thrombolytic therapy with tissue-plasminogen activator (t-PA) to those not receiving thrombolytic therapy. Comparison of findings in the 23 patients who received t-PA intravenously 3 +/- 1 hours after onset of symptoms, with the 38 patients who did not, showed similar baseline characteristics with respect to: age, gender, history of hypertension; location of the infarct; heart weight; severity and numbers of coronary arteries narrowed; and frequencies of plaque rupture, plaque hemorrhage and coronary thrombi. Among the patients receiving t-PA, however, there was a greater frequency of platelet-rich (fibrin-poor) thrombi in the infarct-related coronary arteries (6 of 11 vs 4 of 25 thrombi; p = 0.02), more nonocclusive than occlusive thrombi (6 of 11 vs 4 of 25 thrombi; p = 0.02), and a lower frequency of myocardial rupture (left ventricular free wall or ventricular septum) (5 of 23 [22%] vs 18 of 38 [46%]; p = 0.045).
对61例患者（39名男性，年龄64±11岁）的心脏进行了研究，这些患者在首次致命性急性心肌梗死后5小时至42天（中位数3天）死亡，且未接受经皮腔内冠状动脉成形术或冠状动脉搭桥手术，目的是比较接受组织型纤溶酶原激活剂（t-PA）溶栓治疗的患者与未接受溶栓治疗的患者的临床和心脏形态学特征。将症状发作后3±1小时静脉内接受t-PA治疗的23例患者的结果与未接受治疗的38例患者进行比较，结果显示在以下方面具有相似的基线特征：年龄、性别、高血压病史；梗死部位；心脏重量；冠状动脉狭窄的严重程度和数量；以及斑块破裂、斑块出血和冠状动脉血栓的发生率。然而，在接受t-PA治疗的患者中，梗死相关冠状动脉内富含血小板（纤维蛋白含量低）的血栓发生率更高（11个血栓中有6个，而25个血栓中有4个；p = 0.02），非闭塞性血栓比闭塞性血栓更多（11个血栓中有6个，而25个血栓中有4个；p = 0.02），心肌破裂（左心室游离壁或室间隔）的发生率更低（23例中有5例[22%]，而38例中有18例[46%]；p = 0.045）。
