Erbel R, Düber C, Pop T, von Olshausen K, Treese N, Schuster C J, Meyer J
II. Medizinische Klinik und Poliklinik Johannes-Gutenberg-Universität Mainz.
Klin Wochenschr. 1988;66 Suppl 12:119-27.
The mortality in acute transmural myocardial infarction can be reduced by thrombolytic therapy administered within 6 hours after onset of symptoms. In patients with coronary angiography proven stenosis of less than 70% conservative therapy is recommended. In patients with one vessel disease PTCA in patients with suitable lesions should be used. Further studies have to elucidate, if the angioplasty has to be performed in the acute stage or on an elective basis. PTCA is recommended in patients with occluded coronary vessels and in patients with high grade stenosis and limited coronary blood flow. In patients with multi vessel disease aortocoronary bypass surgery is recommended to reduce high mortality. Long-term results demonstrate, that patients in whom PTCA or coronary bypass surgery was performed demonstrated the highest survival rate.
症状出现后6小时内进行溶栓治疗可降低急性透壁性心肌梗死的死亡率。对于冠状动脉造影证实狭窄小于70%的患者，建议采用保守治疗。对于单支血管病变且有合适病变的患者，应使用经皮冠状动脉腔内血管成形术（PTCA）。还需进一步研究明确血管成形术应在急性期进行还是择期进行。对于冠状动脉闭塞的患者以及严重狭窄且冠状动脉血流受限的患者，建议进行PTCA。对于多支血管病变的患者，建议进行主动脉冠状动脉搭桥手术以降低高死亡率。长期结果表明，接受PTCA或冠状动脉搭桥手术的患者生存率最高。
