de Feyter P J
Int J Cardiol. 1984 Jul;6(1):103-12. doi: 10.1016/0167-5273(84)90256-0.
Intracoronary streptokinase infusion is an exciting new technique, it is feasible and relatively safe, and it can restore antegrade coronary flow in 80% of the patients with an evolving myocardial infarction. Current data indicate that successful reperfusion apparently is associated with improved left ventricular function. The ultimate benefit, a significant decrease in mortality, has not yet been established. Furthermore many questions have not been answered: what is the optimal dosage of streptokinase? How should it be administered: systemic, intracoronary or super selective? Which thrombolytic agent should we use? How can we prevent reocclusion? What is the role of PTCA or acute surgery? A major shortcoming of this technique is the impact on equipment and personnel together with the rather low percentage (25%) of patients with evolving myocardial infarction, in whom this technique is applicable. Of course, although not within the scope of this article, this i.c. streptokinase treatment will have to be compared with other interventions which may reduce morbidity and mortality in patients with acute myocardial infarction. Thus, antegrade flow with i.c. streptokinase can be restored in patients with an evolving myocardial infarction. The main question is: should you do so? Until now, management of patients with an acute myocardial infarction has been conservative and is directed to treatment of pain, arrhythmias and heart failure. At the moment this approach can be considered respectable. For those who propose active management and believe in i.c. streptokinase treatment, until now, insufficient scientific data are available to back this up. For those who have doubts, but like to be active, the best is to put their patients in a well-conducted randomized trial. This will eventually resolve the question: you can, but should you? However, even if i.c. streptokinase is proven to be beneficial to the patient, this technique will not receive widespread application because of its great impact on limited health resources.
冠状动脉内输注链激酶是一项令人振奋的新技术，它可行且相对安全，能使80%的进展性心肌梗死患者恢复冠状动脉前向血流。目前的数据表明，成功的再灌注显然与左心室功能改善相关。最终的益处，即死亡率的显著降低，尚未得到证实。此外，许多问题尚未得到解答：链激酶的最佳剂量是多少？应如何给药：全身给药、冠状动脉内给药还是超选择性给药？我们应该使用哪种溶栓剂？如何预防再闭塞？经皮冠状动脉腔内血管成形术（PTCA）或急诊手术的作用是什么？这项技术的一个主要缺点是对设备和人员的要求较高，而且适用于这项技术的进展性心肌梗死患者比例相当低（25%）。当然，尽管不在本文讨论范围内，但这种冠状动脉内链激酶治疗必须与其他可能降低急性心肌梗死患者发病率和死亡率的干预措施进行比较。因此，进展性心肌梗死患者可通过冠状动脉内链激酶恢复前向血流。主要问题是：你应该这样做吗？到目前为止，急性心肌梗死患者的治疗一直是保守的，主要针对疼痛、心律失常和心力衰竭进行治疗。目前这种方法可以说是合理的。对于那些主张积极治疗并相信冠状动脉内链激酶治疗的人来说，到目前为止，尚无足够的科学数据支持这一观点。对于那些心存疑虑但又希望积极治疗的人来说，最好的办法是将他们的患者纳入一项精心设计的随机试验。这最终将解决这个问题：你可以这样做，但你应该这样做吗？然而，即使冠状动脉内链激酶被证明对患者有益，由于其对有限的卫生资源影响巨大，这项技术也不会得到广泛应用。
