Rovelli F, Mauri F, Roghi A
Department of Cardiology, Niguarda Ca'Granda Hospital, Milan, Italy.
Biomed Pharmacother. 1987;41(8):417-20.
Many studies suggested that the administration of streptokinase (SK) via a coronary catheter or with intravenous treatment is effective in lysing the offending thrombus which is the cause of most acute myocardial infarctions (AMI). The research carried out by the Italian Group for the Study of Streptokinase in Infarct (GISSI) which enrolled a central randomised population of 11,712 patients with AMI, clearly suggests: intravenous infusion of 1.5 million units of SK reduces in-hospital mortality from 13% to 10.7% (P = 0.0002); the decrease in mortality is 47% in patients treated within 1 hour after the onset of pain. The incidence of adverse reaction was low (4.7%). The results of the follow-up (12 months) demonstrate that beneficial effects of SK treatment on mortality were unchanged. Analysis of plasma creatine kinase curves (CK) from 7,632 patients demonstrates that the rate of input and disappearance of CK into the blood was significantly increased in SK patients. In elderly patients (greater than 65 years) the in-hospital mortality was higher (22.4% vs. 7.4%): SK is effective in patients with first AMI (19.1% vs. 22.9%). The incidence of reinfarction in the hospital phase and at the six months follow-up is higher in SK group (7.4% vs. 4.4%). Some questions remain open about the therapeutical approach to the post-thrombolytic phase and about the treatment of residual stenosis.
许多研究表明，通过冠状动脉导管或静脉注射给予链激酶（SK）可有效溶解导致大多数急性心肌梗死（AMI）的血栓。意大利链激酶治疗心肌梗死研究组（GISSI）进行的一项研究纳入了11712例AMI患者的中央随机人群，该研究明确表明：静脉输注150万单位的SK可将住院死亡率从13%降至10.7%（P = 0.0002）；在疼痛发作后1小时内接受治疗的患者中，死亡率降低了47%。不良反应发生率较低（4.7%）。随访（12个月）结果表明，SK治疗对死亡率的有益影响没有改变。对7632例患者的血浆肌酸激酶曲线（CK）分析表明，SK治疗组患者CK进入血液的输入率和消失率显著增加。老年患者（大于65岁）的住院死亡率较高（22.4%对7.4%）：SK对首次发生AMI的患者有效（19.1%对22.9%）。SK组在住院期和六个月随访时的再梗死发生率较高（7.4%对4.4%）。关于溶栓后阶段的治疗方法以及残余狭窄的治疗，仍存在一些问题。
