Chotechuang Yotsawee, Phrommintikul Arintaya, Kuanprasert Srun, Muenpa Roungtiva, Patumanond Jayanton, Chaichuen Tuanchai, Sukonthasarn Apichard
Clinical Epidemiology Program, Chiang Mai University, Chiang Mai, Thailand.
Department of Internal Medicine, Lampang Hospital, Lampang, Thailand.
Heart Asia. 2019 Jun 12;11(2):e011201. doi: 10.1136/heartasia-2019-011201. eCollection 2019.
The benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK.
We randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at Lampang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke).
One hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054).
The delayed coronary intervention (>24 hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention.
NCT02131103.
对于低至中度风险的ST段抬高型心肌梗死（STEMI）患者，在链激酶（SK）治疗后进行早期冠状动脉介入治疗的益处仍不确定。本研究旨在评估低至中度风险的STEMI患者在SK成功治疗后，早期与延迟冠状动脉介入治疗的心血管结局。
我们将兰邦医院和清迈玛哈拉吉那空医院接受全剂量SK成功治疗的STEMI患者，根据全球急性冠状动脉事件注册风险评分随机分为低至中度风险组，再分为早期和延迟冠状动脉介入治疗组。主要终点是30天和6个月时的复合心血管结局（死亡、因急性冠状动脉综合征再次住院、因心力衰竭再次住院和中风）。
我们的研究纳入了162例患者。在30天时，早期冠状动脉介入治疗组的复合心血管结局为4.9%，延迟组为2.5%（p = 0.682）。在6个月时，早期组的复合心血管结局为16.1%，延迟组为6.2%（p = 0.054）。
与早期冠状动脉介入治疗相比，低至中度STEMI患者在SK成功治疗后延迟冠状动脉介入治疗（>24小时）并未增加短期和长期心血管事件。
NCT02131103。
