Vermeer F, Simoons M L, de Feyter P J, Bär F W, Suryapranata H, Fioretti P, Serruys P W, Buis B, Res J C, Braat S H
Department of Cardiology, University Hospital Maastricht, University of Limburg, The Netherlands.
Eur Heart J. 1988 Apr;9(4):346-53. doi: 10.1093/oxfordjournals.eurheartj.a062510.
Immediate PTCA following thrombolysis with streptokinase was performed in 46 out of 533 patients enrolled in a multicentre randomized trial of early reperfusion in patients with acute myocardial infarction. Additional effects of PTCA in patients with a residual diameter stenosis in the infarct-related coronary artery of 70% or more after thrombolysis were compared with successful thrombolysis alone in a matched pair analysis. Thirty six pairs of patients were formed identical with respect to the infarct related coronary artery, presence or absence of previous myocardial infarction, total ST segment elevation on the ECG at admission to the trial, and delay between onset of symptoms and hospital admission. PTCA after thrombolysis did not lead to additional limitation of infarct size, nor to further preservation of left ventricular function. Infarction rate during the three-year follow-up was 14% after PTCA versus 30% after thrombolysis alone (P = 0.05). Similarly, patients had less angina or heart failure after PTCA, since on average 128 out of 156 weeks follow-up were symptom free, while this was only 102 weeks after thrombolysis alone (P = 0.03). Immediate PTCA after thrombolysis with intracoronary streptokinase seems to prevent recurrent ischemia and reinfarction. Further studies should address the proper indication and timing of PTCA after thrombolysis.
在一项针对急性心肌梗死患者早期再灌注的多中心随机试验中，533名患者中有46名在接受链激酶溶栓后立即进行了经皮冠状动脉腔内血管成形术（PTCA）。在配对分析中，将溶栓后梗死相关冠状动脉残余直径狭窄达70%或更高的患者接受PTCA的额外效果与单纯溶栓成功的患者进行了比较。形成了36对患者，这些患者在梗死相关冠状动脉、既往心肌梗死的有无、试验入院时心电图上的总ST段抬高以及症状发作与入院之间的延迟方面均相同。溶栓后进行PTCA并没有导致梗死面积的进一步缩小，也没有进一步保护左心室功能。在三年随访期间，PTCA后的梗死发生率为14%，而单纯溶栓后的梗死发生率为30%（P = 0.05）。同样，PTCA后患者的心绞痛或心力衰竭较少，因为在平均156周的随访中，有128周无症状，而单纯溶栓后只有102周无症状（P = 0.03）。冠状动脉内链激酶溶栓后立即进行PTCA似乎可预防复发性缺血和再梗死。进一步的研究应探讨溶栓后PTCA的合适指征和时机。
