Ambrose J A, Hjemdahl-Monsen C, Borrico S, Sherman W, Cohen M, Gorlin R, Fuster V
J Am Coll Cardiol. 1987 May;9(5):1156-65. doi: 10.1016/s0735-1097(87)80321-2.
Thrombolytic therapy has been shown to be effective in reopening totally occluded arteries in acute myocardial infarction. Coronary thrombus is also believed to play a role in the pathophysiology of unstable angina and non-Q wave infarction. However, few patients with these two acute coronary syndromes have been treated with intracoronary streptokinase. Therefore, 100,000 to 300,000 IU (mean 177,000 +/- 80,000 IU) of intracoronary streptokinase was infused into 36 consecutive catheterized patients who either presented with an acute episode of unstable angina or had had a recent non-Q wave infarction and in whom a less than 100% occluded ischemia-producing artery could be identified. Qualitative techniques utilizing vessel magnification and quantitative analysis with digital subtraction were performed on the ischemia-producing coronary lesion before and immediately after streptokinase therapy and 3 to 10 days later in 18 patients who were restudied at the time of transluminal coronary angioplasty. Before streptokinase treatment, 24 (67%) of 36 ischemia-producing arteries contained eccentric, irregular lesions. The percent diameter stenosis and percent area stenosis in all ischemia-producing arteries averaged 83.8 +/- 8.3% and 94.8 +/- 3.3%, respectively. After streptokinase treatment there were 23 arteries (64%) with eccentric irregular lesions. The percent diameter stenosis and percent area stenosis in all ischemia-producing arteries were similar to pre-streptokinase values (82.9 +/- 5.9% and 93.8 +/- 4.0%, respectively). At restudy, there were also no significant changes in any quantitative or qualitative variable. Five individual patients showed a significant reduction in percent stenosis after streptokinase. This improvement was independent of duration of symptoms, use of heparin before angiography, streptokinase dose or reduction of fibrinogen levels post-streptokinase. Two additional patients deteriorated clinically and developed total occlusion of the ischemia-producing artery within 12 hours of streptokinase infusion. These data suggest that intracoronary streptokinase may be of limited utility in either unstable angina or recent non-Q wave infarction with a less than 100% occluded ischemia-producing artery. In these syndromes, thrombus may be organized or short infusions may be given too late to be effective. In some cases, thrombus may even be absent. Whether longer infusion of streptokinase or other thrombolytic agents will be of benefit remains to be determined.
溶栓疗法已被证明在急性心肌梗死中重新开通完全闭塞的动脉方面是有效的。冠状动脉血栓也被认为在不稳定型心绞痛和非Q波梗死的病理生理学中起作用。然而，很少有这两种急性冠状动脉综合征的患者接受冠状动脉内链激酶治疗。因此，将10万至30万国际单位（平均17.7万±8万国际单位）的冠状动脉内链激酶注入36例连续接受导管插入术的患者体内，这些患者要么表现为不稳定型心绞痛急性发作，要么近期发生过非Q波梗死，且能识别出闭塞程度小于100%的产生缺血的动脉。在18例在冠状动脉腔内血管成形术时再次接受研究的患者中，在链激酶治疗前和治疗后立即以及3至10天后，对产生缺血的冠状动脉病变进行了利用血管放大的定性技术和数字减法的定量分析。在链激酶治疗前，36条产生缺血的动脉中有24条（67%）含有偏心、不规则病变。所有产生缺血的动脉的直径狭窄百分比和面积狭窄百分比平均分别为83.8±8.3%和94.8±3.3%。链激酶治疗后，有23条动脉（64%）出现偏心不规则病变。所有产生缺血的动脉的直径狭窄百分比和面积狭窄百分比与链激酶治疗前的值相似（分别为82.9±5.9%和93.8±4.0%）。在再次研究时，任何定量或定性变量也没有显著变化。5例个体患者在链激酶治疗后狭窄百分比有显著降低。这种改善与症状持续时间、血管造影前肝素的使用、链激酶剂量或链激酶治疗后纤维蛋白原水平的降低无关。另外2例患者临床病情恶化，在链激酶输注后12小时内产生缺血的动脉发生完全闭塞。这些数据表明，冠状动脉内链激酶在不稳定型心绞痛或近期非Q波梗死且产生缺血的动脉闭塞程度小于100%的情况下可能效用有限。在这些综合征中，血栓可能已机化，或者短时间输注可能给予过晚而无效。在某些情况下，甚至可能不存在血栓。链激酶或其他溶栓剂长时间输注是否有益仍有待确定。
