Koshal A, Beanlands D S, Davies R A, Nair R C, Keon W J
Division of Cardiovascular and Thoracic Surgery, University of Ottawa Heart Institute, Ottawa Civic Hospital, Canada.
Circulation. 1988 Sep;78(3 Pt 2):I171-8.
To assess the benefit of immediate surgical reperfusion over conventional medical treatment during the first acute evolving transmural myocardial infarction, 68 patients presenting within 4 hours of onset of chest pain were randomized into a medical group and a surgical group. Both groups were comparable for age, sex, coronary risk factors, location of infarct, and coronary anatomy. Radionuclide global ejection fraction at 48 hours after admission was 45 +/- 15% for the medical group versus 50 +/- 15% for the surgical group; at 3 months, ejection fraction values were 51 +/- 13% and 51 +/- 13%, respectively (p = NS). The average radionuclide wall-motion scores (normal, 3) at 3 months were 2 +/- 0.6 for the medical group and 2 +/- 0.7 for the surgical group. There were three (8.8%) early and four (11.7%) late deaths in the medical group and only one (2.9%) early death in the surgical group. Urgent surgical reperfusion in acute evolving myocardial infarction is a safe and effective procedure that appears to reduce early and late mortality but does not appear to improve left ventricular function.
为评估在首次急性进展性透壁心肌梗死期间，即刻手术再灌注相对于传统药物治疗的益处，将68例在胸痛发作4小时内就诊的患者随机分为药物治疗组和手术治疗组。两组在年龄、性别、冠状动脉危险因素、梗死部位和冠状动脉解剖结构方面具有可比性。入院后48小时，药物治疗组的放射性核素整体射血分数为45±15%，手术治疗组为50±15%；3个月时，射血分数值分别为51±13%和51±13%（p=无显著性差异）。3个月时，药物治疗组的平均放射性核素室壁运动评分（正常为3分）为2±0.6，手术治疗组为2±0.7。药物治疗组有3例（8.8%）早期死亡和4例（11.7%）晚期死亡，手术治疗组仅有1例（2.9%）早期死亡。急性进展性心肌梗死的紧急手术再灌注是一种安全有效的方法，似乎能降低早期和晚期死亡率，但似乎并不能改善左心室功能。
