Cardiac Unit, Fletcher Allen Health Care, University of Vermont, McClure 1, 111 Colchester Avenue, Burlington, VT 05401, USA.
J Thromb Thrombolysis. 2012 Aug;34(2):180-6. doi: 10.1007/s11239-012-0722-x.
What exactly is "pharmacoinvasive therapy" for treatment of patients with ST segment elevation myocardial infarction (STEMI)? When this term was introduced in 2003, it addressed the need for clinical trials besides those comparing fibrinolysis with primary percutaneous coronary intervention (PCI). Primary PCI is recognized as the best strategy for treatment of patients for whom it is applicable. However, use of fibrinolytic drugs initially is necessary in many patients for logistic reasons. Studies of pharmacoinvasive therapy addressed the question of what should be done after initial fibrinolysis. Confusion of the terms pharmacoinvasive therapy, facilitated PCI, rescue PCI, and delayed invasive approaches has obscured the principles that have emerged from such studies. In our view, a uniform conceptualization of pharmacoinvasive therapy emerges on the basis of three key considerations--transfer time, initial pharmacologic therapy, and time to PCI. We propose the following definition: Pharmacoinvasive therapy is the treatment of choice for patients with STEMI who require greater than a 60 min transfer time to a PCI center. It entails immediate use of full doses of fibrinolytic agents followed by prompt transfer to a PCI center and a plan to implement PCI within 2-12 h of the time of onset of initial therapy.
“药物侵入性治疗”究竟是什么，用于治疗 ST 段抬高型心肌梗死（STEMI）患者？当这个术语在 2003 年被引入时，它针对的是除了比较纤溶与直接经皮冠状动脉介入治疗（PCI）之外，还需要临床试验。直接 PCI 被认为是适用于患者的最佳治疗策略。然而，由于后勤原因，最初许多患者都需要使用纤维蛋白溶解药物。药物侵入性治疗的研究解决了初始纤溶后应该做什么的问题。药物侵入性治疗、易化 PCI、补救性 PCI 和延迟性侵入性方法等术语的混淆，掩盖了这些研究中出现的原则。在我们看来，基于三个关键考虑因素——转移时间、初始药物治疗和 PCI 时间，可以对药物侵入性治疗进行统一的概念化。我们提出以下定义：对于需要超过 60 分钟才能转至 PCI 中心的 STEMI 患者，药物侵入性治疗是首选治疗方法。它需要立即使用大剂量的纤维蛋白溶解剂，然后迅速转至 PCI 中心，并计划在初始治疗开始后 2-12 小时内实施 PCI。
