Andreotti F, Roncaglioni M C, Hackett D R, Khan M I, Regan T, Haider A W, Davies G J, Kluft C, Maseri A
Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.
J Am Coll Cardiol. 1990 Dec;16(7):1553-60. doi: 10.1016/0735-1097(90)90300-e.
The effects of early coronary recanalization on the plasma levels of two procoagulant acute phase proteins, the fastacting plasminogen activator inhibitor and von Willebrand factor, were investigated in 24 patients with myocardial infarction receiving intravenous recombinant tissue-type plasminogen activator (rt-PA) within 6 h of the onset of symptoms. Coronary angiography was performed before and 90 min after the start of rt-PA infusion. Continuous electrocardiographic recordings and 4 h plasma creatine kinase MB isoenzyme (CK MB) were performed over the first 24 h. Plasma plasminogen activator inhibitor activity, von Willebrand factor and C-reactive protein were measured before rt-PA infusion, daily for the first 3 days and after 90 days. In the entire group, plasminogen activator inhibitor activity peaked at 24 h (day 1), representing a significant increase over values at all other times (p = 0.03). von Willebrand factor was higher in the first 2 days of infarction compared with after 90 days (p = 0.001). C-reactive protein peaked on day 2, with an eightfold increase over values on admission (p = 0.001). In the 16 patients with a patent infarct-related artery at 90 min, infarct size estimated by integrated 24 h CK MB, time for ST segment elevation to decrease to half-maximum and peak C-reactive protein were reduced significantly by more than twofold compared with values in the 8 patients with an occluded artery at 90 min. The patients with early recanalization also had lower plasminogen activator inhibitor activity on day 2 (p = 0.05) and day 3 (p = 0.02) and lower 0 to 72 h averaged von Willebrand factor (p = 0.01). Thus, early coronary recanalization curtails the response of plasminogen activator inhibitor activity and von Willebrand factor to myocardial infarction, most likely by reducing the extent of ischemia and necrosis and the consequent acute phase reaction. By blunting the early postinfarction procoagulant state, prompt recanalization may reduce the risk of thromboembolic complications in the first days after myocardial infarction.
对24例症状发作6小时内接受静脉注射重组组织型纤溶酶原激活剂（rt-PA）的心肌梗死患者，研究了早期冠状动脉再通对两种促凝血急性期蛋白即快速作用的纤溶酶原激活剂抑制剂和血管性血友病因子血浆水平的影响。在rt-PA输注开始前及开始后90分钟进行冠状动脉造影。在最初24小时内进行连续心电图记录及4小时血浆肌酸激酶MB同工酶（CK MB）检测。在rt-PA输注前、最初3天每天及90天后检测血浆纤溶酶原激活剂抑制剂活性、血管性血友病因子及C反应蛋白。在整个组中，纤溶酶原激活剂抑制剂活性在24小时（第1天）达到峰值，与所有其他时间的值相比有显著升高（p = 0.03）。梗死第1、2天的血管性血友病因子高于90天后（p = 0.001）。C反应蛋白在第2天达到峰值，与入院时的值相比升高了8倍（p = 0.001）。在90分钟时梗死相关动脉通畅的16例患者中，与90分钟时动脉闭塞的8例患者相比，通过24小时综合CK MB估计的梗死面积、ST段抬高降至最大值一半的时间及C反应蛋白峰值显著降低超过两倍。早期再通的患者在第2天（p = 0.05）和第3天（p = 0.02）的纤溶酶原激活剂抑制剂活性也较低，0至72小时平均血管性血友病因子也较低（p = 0.01）。因此，早期冠状动脉再通可减少纤溶酶原激活剂抑制剂活性和血管性血友病因子对心肌梗死的反应，很可能是通过减少缺血和坏死的程度以及随之而来的急性期反应。通过减轻梗死后早期的促凝血状态，及时再通可能降低心肌梗死后最初几天血栓栓塞并发症的风险。
