Maublant J C, Peycelon P, Cardot J C, Verdenet J, Fagret D, Comet M
Division of Nuclear Medicine, Centre Jean Perrin, Clermont-Ferrand, France.
J Nucl Med. 1988 Sep;29(9):1486-91.
In a multicenter randomized double-blind trial comparing heparin and a new fibrinolytic agent, anisoylated plasminogen streptokinase activator complex (APSAC), 231 patients presenting with a less than 5 hr acute myocardial infarction underwent a contrast angiography (CA) before the end of the first week of admission, and radionuclide cardiac blood-pool imaging and a 201Tl single photon emission computed tomography (SPECT) study before the end of the third week. Left ventricular ejection fraction (LVEF) and a wall motion score (WM) were calculated from CA. LVEF was also obtained from cardiac blood-pool imaging, and defect size (DS) from 201Tl SPECT. Results demonstrated that all parameters were significantly improved in patients treated with APSAC versus heparin (contrast LVEF 53 +/- 13 vs. 47 +/- 14 p less than 0.01, WM 9.8 +/- 6.5 vs. 13.3 +/- 7.9 p less than 0.001, radionuclide LVEF 43 +/- 12 vs. 40 +/- 13 p less than 0.05, DS 14 +/- 12 vs. 18 +/- 14 p less than 0.05). When the patients were divided according to infarct site and infarct-related coronary artery patency, it was demonstrated with all four parameters that the beneficial effect of APSAC can be largely explained by the lower incidence of vessel obstruction in this group (37% vs. 77% in the heparin group, p less than 0.001). It is concluded that (a) when compared with heparin and in the conditions of the trial, APSAC significantly improves the cardiac function and decreases the DS and (b) DS measured by 201Tl SPECT is as valuable a quantitative parameter of therapeutic evaluation as are LVEF and WM.
在一项比较肝素与新型纤溶药物茴香酰化纤溶酶原链激酶激活剂复合物（APSAC）的多中心随机双盲试验中，231例急性心肌梗死发病时间小于5小时的患者在入院第一周末前接受了造影血管造影（CA），并在第三周末前接受了放射性核素心血池显像和201铊单光子发射计算机断层扫描（SPECT）研究。根据CA计算左心室射血分数（LVEF）和壁运动评分（WM）。LVEF也可从心血池显像获得，缺损大小（DS）则从201铊SPECT获得。结果表明，与肝素治疗的患者相比，接受APSAC治疗的患者所有参数均有显著改善（造影LVEF 53±13对47±14，p＜0.01；WM 9.8±6.5对13.3±7.9，p＜0.001；放射性核素LVEF 43±12对40±13，p＜0.05；DS 14±12对18±14，p＜0.05）。当根据梗死部位和梗死相关冠状动脉通畅情况对患者进行分组时，所有四个参数均表明，该组血管阻塞发生率较低在很大程度上解释了APSAC的有益作用（37%对肝素组的77%，p＜0.001）。得出的结论是：（a）与肝素相比，在试验条件下，APSAC能显著改善心脏功能并降低DS；（b）201铊SPECT测量的DS作为治疗评估的定量参数与LVEF和WM一样有价值。
