Schwarz F, Eichhorn J, Schuler G, Manthey J, Kübler W
Dtsch Med Wochenschr. 1986 Apr 4;111(14):544-7. doi: 10.1055/s-2008-1068487.
In 24 of 77 patients (31%, group A), successfully treated by intracoronary streptokinase infusion in the acute stage of a transmural myocardial infarction, reocclusion of the infarct artery occurred within four weeks, in 15 patients with, in the remaining nine without re-infarction symptoms. The age of the patients, frequency of single, double or triple-vessel disease, number of anterior and posterior wall infarcts, creatine-kinase activity before and during treatment, and degree of stenosis at first contrast-medium injection were all comparable in the patients with or without re-occlusion (53 patients, group B). At the end of the acute treatment, in five patients of group A (21%) and in 17 of group B (32%) combined with balloon dilatation at the same time as the infusion, residual stenosis was significantly higher in group A than group B (75%) and 62%, respectively; P less than 0.001). No patient with a residual stenosis of less than 50% (18, of whom 12 had balloon dilatation) had a re-occlusion.
A residual stenosis of at least 50% after initially successful thrombolysis presents a marked re-infarction risk and should lead to a second intervention in such cases.
在77例患者中的24例（31%，A组），在透壁性心肌梗死急性期通过冠状动脉内输注链激酶成功治疗，梗死相关动脉在4周内再闭塞，其中15例伴有再梗死症状，其余9例无再梗死症状。再闭塞患者和未再闭塞患者（53例，B组）在患者年龄、单支、双支或三支血管病变频率、前后壁梗死数量、治疗前和治疗期间的肌酸激酶活性以及首次注射造影剂时的狭窄程度方面均具有可比性。在急性治疗结束时，A组5例患者（21%）和B组17例患者（32%）在输注的同时联合球囊扩张，A组的残余狭窄（75%）显著高于B组（62%）；P<0.001）。残余狭窄小于50%的患者（18例，其中12例进行了球囊扩张）均未发生再闭塞。
初始溶栓成功后残余狭窄至少50%存在明显的再梗死风险，在这种情况下应进行二次干预。
