Vermeer F, Simoons M L, de Zwaan C, van Es G A, Verheugt F W, van der Laarse A, van Hoogenhuyze D C, Azar A J, van Dalen F J, Lubsen J
Working Group on Thrombolytic Therapy in Acute Myocardial Infarction of the Interuniversity Cardiology Institute of The Netherlands.
Br Heart J. 1988 May;59(5):527-34. doi: 10.1136/hrt.59.5.527.
The costs and benefits of early thrombolytic treatment with intracoronary streptokinase in acute myocardial infarction were compared in a randomised trial. All hospital admissions were recorded and the functional class was assessed at visits to the outpatient clinic during a 12 month follow up of 269 patients allocated to thrombolytic treatment and of 264 allocated to conventional treatment. Mean survival during the first year was calculated for patients with inferior and with anterior infarction and adjusted for impaired quality of life in cases where there were symptoms or hospital admission. In patients with inferior infarction mean survival was 337 days (out of a total follow up of 365 days) for patients allocated to thrombolytic treatment and 327 days for controls. Quality adjusted survival was seven days longer in the thrombolysis group (307 vs 300 days in controls). In patients with anterior infarction mean survival was significantly longer (35 days) in the thrombolysis group than in the control group as was quality adjusted survival (38 days) (304 vs 266 days in controls). The gain in life expectancy with thrombolytic treatment was 0.7 years for patients with inferior infarction, 2.4 years for patients with anterior infarction, and 3.6 years for the subset of patients with large anterior infarction who were admitted within two hours of the onset of symptoms. The costs of medical treatment, including medication, hospital stay, cardiac catheterisation, coronary angioplasty, and bypass surgery, in the first year follow up were higher inpatients allocated to thrombolytic treatment (an additional cost ofDfl 7000 in inferior and Dfl 9000in anterior infarction (1 pounds sterling approximately Dfl 3.3.)) than in conventionally treated patients. The additional costs per year of life gained were Dfl 10 000 in inferior infarction, Dfl 3 800 in anterior infarction, and only Dfl 1 900 in patients with large anterior infarction admitted within two hours of onset of symptoms. Intracoronary thrombolysis can be recommended as a cost effective treatment in patients with extensive anteroseptal infarction.
在一项随机试验中，对急性心肌梗死患者早期冠状动脉内注射链激酶进行溶栓治疗的成本和效益进行了比较。记录了所有住院病例，并在对269例接受溶栓治疗和264例接受传统治疗的患者进行12个月随访期间，在门诊就诊时评估了其心功能分级。计算了下壁梗死和前壁梗死患者第一年的平均生存期，并对有症状或住院的患者生活质量受损情况进行了调整。在下壁梗死患者中，接受溶栓治疗的患者平均生存期为337天（总随访期为365天），对照组为327天。溶栓组的质量调整生存期比对照组长7天（307天对300天）。在前壁梗死患者中，溶栓组的平均生存期（长35天）和质量调整生存期（长38天）均显著长于对照组（304天对266天）。下壁梗死患者接受溶栓治疗后的预期寿命增加0.7年，前壁梗死患者增加2.4年，症状发作后两小时内入院的大面积前壁梗死患者亚组增加3.6年。在第一年随访中，接受溶栓治疗的患者的医疗费用，包括药物治疗、住院、心导管检查、冠状动脉成形术和搭桥手术，高于接受传统治疗的患者（下壁梗死额外费用为7000荷兰盾，前壁梗死为9000荷兰盾（1英镑约合3.3荷兰盾））。下壁梗死患者每获得一年生命的额外费用为10000荷兰盾，前壁梗死患者为3800荷兰盾，症状发作后两小时内入院的大面积前壁梗死患者仅为1900荷兰盾。冠状动脉内溶栓可作为广泛前间隔梗死患者的一种具有成本效益的治疗方法推荐使用。
