Koren G, Luria M H, Weiss A T, Kriwisky M, Mosseri M, Lotan C, Applebaum D, Welber S, Sapoznikov D, Ben-David Y
Arch Intern Med. 1987 Feb;147(2):237-40.
Fifty-one successive patients treated with intravenous streptokinase 1.7 +/- 0.8 (mean +/- SD) hours after onset of symptoms of acute myocardial infarction were evaluated during a three-month posthospital follow-up period. Coronary angiography was performed four to nine days after the initial hospital admission. Twenty-eight patients had a second late angiogram. Forty-one patients had successful reperfusion but only 25% of all patients were without significant clinical cardiovascular manifestations during this period. Postmyocardial infarction angina pectoris occurred in 21 patients, an abnormal stress test result was present in 28 patients, eight patients developed congestive heart failure, and five patients had reinfarction. An intervention with percutaneous transluminal coronary angioplasty or coronary artery bypass graft was performed in 15 (37%) of 41 reperfused patients. A significantly higher intervention rate was present in patients treated with streptokinase within one hour following the onset of symptoms. Early reocclusion (within three months of the infarct) was noted in patients with 60% or more residual stenosis in their infarct-related coronary artery. These patients also had a significantly greater incidence of angina pectoris. Our findings indicate that early thrombolytic therapy of acute myocardial infarction preserves myocardium, and since the infarct-related artery is patent, but narrowed, the jeopardized area is responsible for a high-risk syndrome with an increased likelihood of ischemic symptoms. An early aggressive approach may be indicated, especially for patients with greater than 60% residual stenosis in their infarct-related coronary artery.
对51例急性心肌梗死症状发作后1.7±0.8（均值±标准差）小时接受静脉链激酶治疗的连续患者，在出院后三个月的随访期内进行了评估。在首次入院后四至九天进行冠状动脉造影。28例患者进行了第二次后期血管造影。41例患者实现了成功再灌注，但在此期间所有患者中只有25%没有明显的临床心血管表现。21例患者发生心肌梗死后心绞痛，28例患者应激试验结果异常，8例患者出现充血性心力衰竭，5例患者发生再梗死。41例再灌注患者中有15例（37%）接受了经皮腔内冠状动脉成形术或冠状动脉搭桥术干预。症状发作后一小时内接受链激酶治疗的患者干预率明显更高。梗死相关冠状动脉残余狭窄60%或以上的患者出现早期再闭塞（梗死三个月内）。这些患者心绞痛的发生率也明显更高。我们的研究结果表明，急性心肌梗死的早期溶栓治疗可保护心肌，并且由于梗死相关动脉通畅但狭窄，受危及区域导致了具有缺血症状增加可能性的高危综合征。可能需要采取早期积极的方法，尤其是对于梗死相关冠状动脉残余狭窄大于60%的患者。
