Gurevitch J, Mosseri M, Lotan C, Sapoznikov D, Gotsman M S
Harefuah. 1989 Jan 1;116(1):6-11.
In a series of 30 patients with acute myocardial infarction (AMI) intravenous streptokinase was given within 4 hours of the onset of chest pain. Cardiac catheterization and angiography were performed on the 6th day, and again 4 months after the acute episode. Residual coronary artery stenosis increased significantly (from 84 +/- 3% to 95 +/- 7%, p less than 0.05) in those who had stenosis of more than 80% in infarct-related arteries. In this subgroup, a higher incidence of complete occlusion was found at the second investigation than in the other patients (p less than 0.002). Those who had received early treatment with streptokinase or had residual stenosis of less than 75% showed improvement in regional function of the infarct area, confirmed at the second angiography. End-systolic volume, regarded as a sensitive prognostic marker after myocardial infarction, correlated at the second investigation with residual coronary artery stenosis determined on day 6 (p less than 0.0016). Significant improvement in global ventricular function and return of regional function to normal was found in those who had received streptokinase within 2 hours of onset of pain, and in whom residual coronary artery stenosis was less than 75%. Early fibrinolytic treatment at the time of infarction is crucial for preservation of ventricular function and its later restoration. Coronary angiography 1 week after infarction detects high-risk patients who need early revascularization.
在一系列30例急性心肌梗死（AMI）患者中，胸痛发作4小时内给予静脉链激酶治疗。在第6天以及急性发作后4个月再次进行心脏导管插入术和血管造影。梗死相关动脉狭窄超过80%的患者，残余冠状动脉狭窄显著增加（从84±3%增至95±7%，p<0.05）。在该亚组中，第二次检查时完全闭塞的发生率高于其他患者（p<0.002）。接受链激酶早期治疗或残余狭窄小于75%的患者，梗死区域功能在第二次血管造影时得到证实有所改善。心肌梗死后被视为敏感预后标志物的收缩末期容积，在第二次检查时与第6天测定的残余冠状动脉狭窄相关（p<0.0016）。在疼痛发作2小时内接受链激酶治疗且残余冠状动脉狭窄小于75%的患者中，发现整体心室功能显著改善且梗死区域功能恢复正常。梗死时早期纤溶治疗对于维持心室功能及其后期恢复至关重要。梗死后1周进行冠状动脉造影可检测出需要早期血运重建的高危患者。
