Koren G, Weiss A T, Hasin Y, Appelbaum D, Welber S, Rozenman Y, Lotan C, Mosseri M, Sapoznikov D, Luria M H
N Engl J Med. 1985 Nov 28;313(22):1384-9. doi: 10.1056/NEJM198511283132204.
We evaluated the effectiveness of early intravenous administration of 750,000 units of streptokinase in 53 patients with acute myocardial ischemia treated by a mobile-care unit at home (9 patients) or in the hospital (44 patients). Treatment was begun an average (+/- S.D.) of 1.7 +/- 0.8 hours from the onset of pain. Non-Q-wave infarctions developed subsequently in eight patients, whereas all the others had typical Q-wave infarct patterns. In 81 per cent of the patients the infarct-related artery was patent at angiography performed four to nine days after admission. Vessel patency was independent of the time of treatment, but residual left ventricular function was time dependent. Patients treated less than 1.5 hours after the onset of pain had a significantly higher ejection fraction (56 +/- 15 vs. 47 +/- 14 per cent; P less than 0.05) and infarct-related regional ejection fraction (51 +/- 19 vs. 34 +/- 20 per cent; P less than 0.01) and a lower QRS score (5.6 +/- 4.9 vs. 8.6 +/- 5.5; P less than 0.01) than patients receiving treatment between 1.5 and 4 hours after the onset of pain. Patients treated earlier by the mobile-care unit also had better-preserved left ventricular function than patients treated in the hospital. We conclude that thrombolytic therapy with streptokinase is most effective if given within the first 1.5 hours after the onset of symptoms of acute myocardial infarction.
我们评估了早期静脉注射750,000单位链激酶对53例急性心肌缺血患者的疗效，这些患者在家中（9例）或医院（44例）由流动护理单元进行治疗。治疗平均在疼痛发作后1.7±0.8小时开始（±标准差）。随后有8例患者发生非Q波梗死，而其他所有患者均有典型的Q波梗死模式。在81%的患者中，入院后4至9天进行血管造影时，梗死相关动脉通畅。血管通畅与治疗时间无关，但左心室残余功能与时间有关。疼痛发作后1.5小时内接受治疗的患者，其射血分数（56±15%对47±14%；P<0.05）和梗死相关区域射血分数（51±19%对34±20%；P<0.01）显著更高，QRS评分更低（5.6±4.9对8.6±5.5；P<0.01），而疼痛发作后1.5至4小时接受治疗的患者则相反。流动护理单元早期治疗的患者左心室功能也比在医院治疗的患者保存得更好。我们得出结论，急性心肌梗死症状发作后1.5小时内给予链激酶溶栓治疗最为有效。
