de Zwaan C, Bar F W, Janssen J H, de Swart H B, Vermeer F, Wellens H J
Department of Cardiology, University of Limburg, Academic Hospital, Maastricht, The Netherlands.
J Am Coll Cardiol. 1988 Aug;12(2):301-9. doi: 10.1016/0735-1097(88)90398-1.
The incidence of intracoronary thrombus and the effects of thrombolytic therapy were studied in 41 patients with unstable angina. All patients underwent coronary angiography 2 to 69 h (mean 19) after their last attack of chest pain. Immediately after angiography, 21 patients received intracoronary streptokinase (250,000 IU in 45 min) and were retrospectively analyzed. Twenty patients received intravenous recombinant tissue-type plasminogen activator (rt-PA) (100 mg in 3 h) and were involved in a prospective study. Eleven of the 21 patients from the streptokinase group and 11 of the 20 patients from the rt-PA group showed a decrease in the severity of the coronary stenosis on repeat angiography 1 day later. A decrease in coronary obstruction was primarily observed in 10 of 13 patients with a complete stenosis and in 6 of 9 patients with a subtotal stenosis and markedly diminished coronary flow. Improvement in coronary anatomy was not determined by the clinical characteristics of the patients. Twenty-eight of the 41 patients had angiographic evidence of intracoronary thrombus formation before and 16 had such evidence after thrombolytic treatment. Nine patients developed a small increase in serum cardiac enzymes before or during treatment. Ischemic symptoms and the incidence of surgical or angioplastic intervention were not different in patients with or without a reduction in coronary artery stenosis after fibrinolytic therapy. These observations suggest a high incidence of coronary thrombosis in patients with unstable angina. The data do not permit assessment of the clinical therapeutic efficacy of thrombolytic therapy. Better risk stratification and placebo-controlled prospective studies are required to obtain information on the risk/benefit ratio of such therapy in unstable angina.
对41例不稳定型心绞痛患者的冠状动脉内血栓形成发生率及溶栓治疗效果进行了研究。所有患者在最后一次胸痛发作后2至69小时（平均19小时）接受了冠状动脉造影。冠状动脉造影后立即对21例患者进行冠状动脉内链激酶治疗（45分钟内给予25万国际单位），并进行回顾性分析。20例患者接受静脉注射重组组织型纤溶酶原激活剂（rt-PA）（3小时内给予100毫克），并参与一项前瞻性研究。链激酶组的21例患者中有11例，rt-PA组的20例患者中有11例在1天后重复冠状动脉造影时显示冠状动脉狭窄程度减轻。冠状动脉阻塞的减轻主要见于13例完全狭窄患者中的10例以及9例次全狭窄且冠状动脉血流明显减少患者中的6例。冠状动脉解剖结构的改善并不取决于患者的临床特征。41例患者中有28例在溶栓治疗前有冠状动脉内血栓形成的血管造影证据，16例在溶栓治疗后有此类证据。9例患者在治疗前或治疗期间血清心肌酶略有升高。溶栓治疗后冠状动脉狭窄减轻或未减轻的患者，其缺血症状以及手术或血管成形术干预的发生率并无差异。这些观察结果提示不稳定型心绞痛患者冠状动脉血栓形成的发生率较高。这些数据无法评估溶栓治疗的临床疗效。需要更好的风险分层和安慰剂对照的前瞻性研究，以获取关于此类治疗在不稳定型心绞痛中风险/效益比的信息。
