Schmutzler H, Rutsch W, Schartl M, Eichstädt H, Jatzkewitz A
Herz. 1986 Feb;11(1):1-8.
Long term results of thrombolytic therapy in myocardial infarction are determined primarily by the effects of treatment in the acute phase. Out of a total of 370 patients undergoing recanalization therapy, 170 consecutive patients were examined over a period of one to three years (mean 1.5 years) by means of ECG, exercise testing, thallium myocardial scintigraphy, radionuclide ventriculography, coronary angiography and contrast ventriculography. Frequency of chest pain, left ventricular function, reinfarction rate and mortality were analyzed. The patient cohort was divided into three subgroups: 1. patients with successful PTCR who underwent PTCA or bypass graft surgery; 2. patients with successful PTCR who were managed medically without subsequent reinfarction; 3. patients with definitive occlusion or reinfarction. Mortality in the hospital phase (within 30 days) was 4.9% in patients undergoing successful recanalization procedures as compared to 12.3% for patients with definitive occlusion. Late mortality at 1.5 years was 12.3% and 16.2%, respectively. These figures are similar to those found in the literature. In-hospital mortality is clearly reduced by early recanalization within 200 minutes of occlusion, and there is a reduction in the ultimate extent of infarction as well as improvement in left ventricular function. In order to prevent reocclusion (in 10 to 20% of cases) and reinfarction additional interventions such as PTCA or bypass grafting should be employed as soon as possible in suitable cases.(ABSTRACT TRUNCATED AT 250 WORDS)
心肌梗死溶栓治疗的长期结果主要取决于急性期治疗的效果。在总共370例接受再灌注治疗的患者中，对170例连续患者进行了为期1至3年（平均1.5年）的检查，检查手段包括心电图、运动试验、铊心肌闪烁显像、放射性核素心室造影、冠状动脉造影和对比心室造影。分析了胸痛频率、左心室功能、再梗死率和死亡率。患者队列分为三个亚组：1. 成功进行经皮冠状动脉腔内血管成形术（PTCR）并接受了经皮冠状动脉腔内血管成形术（PTCA）或搭桥手术的患者；2. 成功进行PTCR且药物治疗后未发生再梗死的患者；3. 存在明确闭塞或再梗死的患者。成功进行再灌注手术的患者在住院期（30天内）的死亡率为4.9%，而存在明确闭塞的患者为12.3%。1.5年时的晚期死亡率分别为12.3%和16.2%。这些数字与文献中的数据相似。在闭塞后200分钟内尽早进行再灌注可明显降低住院死亡率，同时梗死的最终范围缩小，左心室功能改善。为预防再闭塞（10%至20%的病例）和再梗死，在合适的病例中应尽快采用PTCA或搭桥等额外干预措施。（摘要截选至250词）
