Dodge H T, Sheehan F H, Mathey D G, Brown B G, Kennedy J W
Circulation. 1985 Dec;72(6 Pt 2):V39-45.
Intracoronary streptokinase (STK) was given to 52 patients and 2 million U of intravenous urokinase was given to 15 patients with acute myocardial infarction less than 3 hr from onset of symptoms. Wall motion in the infarct region improved in 20 patients receiving STK alone (-2.5 +/- 1 to 2.1 +/- 1.1 SD/chord) and in 22 patients receiving STK and undergoing coronary bypass surgery within 24 hr (-2.5 +/- 1 to -1.5 +/- 1.0 SD/chord). Wall motion was unchanged in 10 patients not successfully reperfused with STK (-2.9 +/- 0.7 to -3.1 +/- 0.7 SD/chord). Regional wall motion improved at least 1.0 SD/chord in 71% of 14 patients treated within 2 hr of onset of symptoms, but in only 29% of 34 treated after 2 hr. Mean coronary artery stenosis after thrombolysis was 77 +/- 9%. Rethrombosis was associated with a stenotic cross-sectional area of less than 0.4 mm2. Ventricular function did not improve, with a residual stenosis of 0.4 mm or less in diameter. The Western Washington randomized trial reported a 1 year mortality of 2.5% in 80 successfully reperfused patients, but a mortality of 23% in 13 in whom reperfusion was partial and of 14.6% in 41 in whom reperfusion failed. The improved survival with successful reperfusion and improved ventricular performance with early and more complete reperfusion has stimulated interest in the need for angioplasty and coronary artery bypass grafting after thrombolytic therapy.
对52例患者给予冠状动脉内链激酶（STK），对15例症状发作后不到3小时的急性心肌梗死患者给予200万单位静脉注射尿激酶。单独接受STK的20例患者梗死区域的壁运动得到改善（-2.5±1至2.1±1.1标准差/弦），22例接受STK并在24小时内接受冠状动脉搭桥手术的患者梗死区域的壁运动也得到改善（-2.5±1至-1.5±1.0标准差/弦）。10例未成功接受STK再灌注的患者壁运动未改变（-2.9±0.7至-3.1±0.7标准差/弦）。症状发作后2小时内接受治疗的14例患者中有71%区域壁运动改善至少1.0标准差/弦，但症状发作后2小时后接受治疗的34例患者中只有29%区域壁运动改善。溶栓后平均冠状动脉狭窄为77±9%。再血栓形成与狭窄横截面积小于0.4平方毫米有关。心室功能未改善，残余狭窄直径为0.4毫米或更小。华盛顿西部随机试验报告，80例成功再灌注患者的1年死亡率为2.5%，13例部分再灌注患者的死亡率为23%，41例再灌注失败患者的死亡率为14.6%。成功再灌注带来的生存改善以及早期和更完全再灌注带来的心室功能改善激发了人们对溶栓治疗后进行血管成形术和冠状动脉搭桥术必要性的兴趣。
