von Essen R, Uebis R, Schmidt W, Dörr R, Merx W, Meyer J, Effert S, Schweizer P, Erbel R, Bardos P
Dtsch Med Wochenschr. 1985 Apr 12;110(15):570-5.
Between March 1980 and July 1984, coronary angiography was performed on 461 consecutive patients (no age limit) with acute myocardial infarction, and the partially or completely obstructing thrombus lysed by selective intracoronary infusion of streptokinase. At the time of first coronary angiography 96 patients (21%) had a high degree of stenosis but no total occlusion of the infarct vessel (group A). In 365 patients (79%) there was complete occlusion which in 315 patients (86%) was removed successfully after an occlusion period of 213 +/- 87 minutes (group B). In 50 patients (14%) (group C) attempts at reperfusion failed. In 129 of 163 patients (79.1%) with one-vessel disease, PTCA (percutaneous transluminal coronary angioplasty) was successful. Patients with multiple-vessel disease and an occlusion time of less than four hours, on the other hand, were treated surgically within the first ten days (78 patients). In the remaining 254 patients conservative treatment was practised. Within the first 30 days there were seven deaths (14%) in group C, while among group A and B patients, under conservative treatment, 16 died (7.8%). After successful PTCA four patients (3.1%) died. The lowest mortality was among patients with a short occlusion time and early bypass operation (2.6%). The most frequent cause of death was cardiogenic shock (20 of 29 patients), more rarely ventricular fibrillation (3) or other causes (4). Ventricular rupture occurred in three patients, one of whom was saved by pericardial tap. One year later the mortality among the conservative group was 21.2%, after successful PTCA or bypass operation 9.3% and 6.4%, respectively.
1980年3月至1984年7月期间，对461例连续的急性心肌梗死患者（无年龄限制）进行了冠状动脉造影，并通过选择性冠状动脉内输注链激酶溶解了部分或完全阻塞的血栓。首次冠状动脉造影时，96例患者（21%）存在高度狭窄但梗死血管未完全闭塞（A组）。365例患者（79%）存在完全闭塞，其中315例患者（86%）在闭塞213±87分钟后成功再通（B组）。50例患者（14%）（C组）再灌注尝试失败。163例单支血管病变患者中有129例（79.1%）经皮腔内冠状动脉成形术（PTCA）成功。另一方面，多支血管病变且闭塞时间少于4小时的患者在头十天内接受了手术治疗（78例）。其余254例患者采用保守治疗。在最初30天内，C组有7例死亡（14%），而A组和B组患者在保守治疗下有16例死亡（7.8%）。PTCA成功后有4例患者（3.1%）死亡。死亡率最低的是闭塞时间短且早期进行搭桥手术的患者（2.6%）。最常见的死亡原因是心源性休克（29例患者中有20例），较少见的是心室颤动（3例）或其他原因（4例）。3例患者发生心室破裂，其中1例经心包穿刺引流获救。一年后，保守治疗组的死亡率为21.2%，PTCA成功或搭桥手术后分别为9.3%和6.4%。
