Feit F, Mueller H S, Braunwald E, Ross R, Hodges M, Herman M V, Knatterud G L
Department of Medicine, New York University School of Medicine, New York.
J Am Coll Cardiol. 1990 Dec;16(7):1529-34. doi: 10.1016/0735-1097(90)90295-z.
In the conservative strategy arm of phase II of the Thrombolysis in Myocardial Infarction (TIMI) trial, 1,461 patients were treated with intravenous recombinant tissue-type plasminogen activator (rt-PA). Coronary angiography, with angioplasty if feasible, was to be performed only for recurrent spontaneous or exercise-induced ischemia. In this study results in patients treated by this strategy in community and tertiary hospitals are compared. Despite similar baseline findings in the two groups, coronary angiography was performed within 42 days in more patients (542 [48%] of 1,155) initially admitted to a tertiary hospital (on-site coronary angiography/angioplasty available) than in those (94 [32%] of 306) admitted to a community hospital (transfer to tertiary hospital for coronary angiography/angioplasty) (p less than 0.001). This different approach resulted in a greater use of coronary angioplasty (203 [18%] of 1,155 versus 32 [11%] of 306, p less than 0.01), coronary artery bypass surgery (133 [12%] of 1,155 versus 23 [8%] of 306, p less than 0.05) and blood transfusions (139 [12%] of 1,155 versus 17 [5.5%] of 306, p less than 0.001) in patients admitted to a tertiary than to a community hospital. However, there were no significant differences between the two groups in mortality, recurrent myocardial infarction or left ventricular function. These results demonstrate that a conservative strategy after treatment of acute myocardial infarction with rt-PA is applicable in the community hospital setting.
在心肌梗死溶栓治疗（TIMI）试验的II期保守治疗策略组中，1461例患者接受了静脉注射重组组织型纤溶酶原激活剂（rt-PA）治疗。仅在复发性自发性或运动诱发的缺血时，才进行冠状动脉造影，可行时进行血管成形术。在本研究中，比较了社区医院和三级医院采用该策略治疗的患者的结果。尽管两组的基线检查结果相似，但最初入住三级医院（可进行现场冠状动脉造影/血管成形术）的患者中，更多患者（1155例中的542例[48%]）在42天内进行了冠状动脉造影，而入住社区医院（转至三级医院进行冠状动脉造影/血管成形术）的患者中，这一比例为306例中的94例[32%]（p<0.001）。这种不同的治疗方法导致三级医院的患者比社区医院的患者更多地接受冠状动脉血管成形术（1155例中的203例[18%]对306例中的32例[11%]，p<0.01）、冠状动脉旁路移植术（1155例中的133例[12%]对306例中的23例[8%]，p<0.05）和输血（1155例中的139例[12%]对306例中的17例[5.5%]，p<0.001）。然而，两组在死亡率、再发心肌梗死或左心室功能方面无显著差异。这些结果表明，rt-PA治疗急性心肌梗死后的保守治疗策略适用于社区医院环境。
