Feldman R L, Hill J A, Conti C R, Pepine C J
Am Heart J. 1984 Apr;107(4):823-5. doi: 10.1016/0002-8703(84)90353-3.
Intracoronary application of thrombolytic agents, particularly streptokinase, can recanalize arteries that had been totally occluded in patients with evolving acute myocardial infarction (AMI). Numerous uncontrolled trials have testified to the effectiveness of thrombolytic therapy in most patients in reestablishing flow to the infarct-related coronary artery. Follow-up of patients in whom reperfusion has been established has often demonstrated small but significant increases in the left ventricular ejection fraction. In contrast, in other patients in whom thrombolytic therapy failed to reopen the occluded vessel, the left ventricular ejection fraction usually does not change during follow-up. In most reported uncontrolled trials, few complications are described and the mortality rate in patients treated by this therapy may be lower than expected. These data have been used as the basis for widespread application of this technique in many catheterization laboratories around the world. Our initial experience at the University of Florida in 23 patients has not been as successful as other uncontrolled trials previously reported. Reperfusion was accomplished in only 12 patients. Of 17 who survived their AMI, only five demonstrated an improved left ventricular ejection fraction of at least 10%. Serious complications, including bleeding from catheterization sites or allergic reactions to streptokinase, occurred. Controlled trials to critically evaluate this new therapy are needed and are in progress.
冠状动脉内应用溶栓剂，尤其是链激酶，可使进展期急性心肌梗死（AMI）患者中已完全闭塞的动脉再通。众多非对照试验证实，溶栓治疗对大多数患者重建梗死相关冠状动脉血流是有效的。对已实现再灌注的患者进行随访，常显示左心室射血分数虽有小幅但显著的增加。相比之下，在其他溶栓治疗未能使闭塞血管再通的患者中，随访期间左心室射血分数通常无变化。在大多数报道的非对照试验中，描述的并发症很少，接受该治疗的患者死亡率可能低于预期。这些数据已成为全球许多导管实验室广泛应用该技术的依据。我们佛罗里达大学最初对23例患者的经验并不像先前报道的其他非对照试验那样成功。仅12例患者实现了再灌注。在17例存活的AMI患者中，只有5例显示左心室射血分数至少提高了10%。出现了严重并发症，包括导管插入部位出血或对链激酶的过敏反应。需要并正在进行严格评估这种新疗法的对照试验。
