Marx B E, Bertel O, Baumann P C, Koller M, Steinbrunn W, Dürst U, Speiser K
Zürcher Arbeitsgemeinschaft Fibrinolyse bei akutem Myokardinfarkt, Lyseregister Zürcher Spitäler, Medizinische Klinik, Stadtspital Triemli, Zürich.
Schweiz Med Wochenschr. 1988 Nov 26;118(47):1753-7.
We report the results of i.v. fibrinolysis in patients with acute myocardial infarction treated in four major hospitals in Zürich. Between 1986 and 1988 only 96 (9%) of 1069 patients admitted to intensive care units with acute myocardial infarction received thrombolytic therapy (less than 3 hours after onset of symptoms), 7% (50/703) during the first treatment period (streptokinase for 14 months), 13% (46/306) during the second treatment period (rt-PA for 8 months). The hospital mortality was 4% and severe complications of fibrinolytic therapy occurred in 4%. Coronary angiography was performed in 60% of patients in 1986/87 and in 87% in 1987/88. Despite this significant increase in invasive diagnostic procedures the percentage of patients after thrombolysis qualifying for invasive therapy remained unchanged at 53%. The indications for PTCA or bypass surgery were postinfarct angina in 41%, silent ischemia in 5%, left main coronary artery stenosis or multivessel disease with reduced left ventricular ejection fraction in 16%, and residual high grade stenosis with preserved contractility of the infarct-related myocardium in 38%. The mean in-hospital stay was 16 days, with significant variation from 13 to 22 days between the different hospitals (p less than 0.05). In the follow-up of 65 men aged below 65 years, 75% of the patients undergoing invasive therapy and 65% of those treated medically had returned to work 6 months after myocardial infarction. Due to the limited possibility of detecting viable myocardium by non-invasive methods, and the high rate of invasive therapy necessary in our patients, further management after thrombolysis should generally include large scale coronary angiography.(ABSTRACT TRUNCATED AT 250 WORDS)
我们报告了在苏黎世四家主要医院接受治疗的急性心肌梗死患者静脉溶栓治疗的结果。1986年至1988年期间，1069名入住重症监护病房的急性心肌梗死患者中，只有96名（9%）接受了溶栓治疗（症状发作后不到3小时），在第一个治疗期（链激酶治疗14个月）为7%（50/703），在第二个治疗期（rt-PA治疗8个月）为13%（46/306）。医院死亡率为4%，溶栓治疗的严重并发症发生率为4%。1986/87年60%的患者和1987/88年87%的患者接受了冠状动脉造影。尽管侵入性诊断程序有显著增加，但溶栓后符合侵入性治疗条件的患者百分比仍保持在53%不变。PTCA或搭桥手术的指征为：梗死后心绞痛占41%，无症状性心肌缺血占5%，左主干冠状动脉狭窄或多支血管病变伴左心室射血分数降低占16%，梗死相关心肌收缩功能正常但残留高度狭窄占38%。平均住院时间为16天，不同医院之间有显著差异，从13天到22天不等（p<0.05）。在对65名65岁以下男性的随访中，接受侵入性治疗的患者中有75%，接受药物治疗的患者中有65%在心肌梗死后6个月恢复了工作。由于通过非侵入性方法检测存活心肌的可能性有限，且我们的患者中侵入性治疗的比例较高，溶栓后的进一步治疗通常应包括大规模冠状动脉造影。（摘要截短于250字）
