Marder V J, Francis C W
Am J Med. 1984 Nov;77(5):921-8. doi: 10.1016/0002-9343(84)90543-6.
The application of coronary angiography in coordination with streptokinase administration directly into the occluded coronary artery has served to focus attention on the clinical potential of such therapy. About 75 percent of patients with acute transmural myocardial infarction have been shown to have reperfusion after intracoronary administration of streptokinase. However, the data do not prove that the beneficial effect required regional perfusion. Analysis of biochemical data suggests that the active agent was not confined to the locale of the thrombus, but in fact circulated in significant concentration; furthermore, systemic (intravenous) treatment resulted in reperfusion of a significant proportion (50 percent) of coronary arteries as well. Comparative studies are needed to critically compare angiographic results after regional or systemic therapy and also to assess the impact of reperfusion on possible reduction in long-term morbidity and mortality. Although intracoronary therapy appears to be more effective for inducing reperfusion, intravenous therapy has the potential for greater clinical impact, since it can be instituted more quickly after the onset of symptoms and does not require specialized cardiac catheterization facilities.
将冠状动脉造影与链激酶直接注入闭塞冠状动脉相结合的应用，已使人们将注意力集中在这种治疗方法的临床潜力上。约75%的急性透壁性心肌梗死患者在冠状动脉内注射链激酶后已实现再灌注。然而，数据并未证明有益效果需要局部灌注。生化数据分析表明，活性剂并不局限于血栓部位，实际上是以显著浓度循环的；此外，全身（静脉）治疗也使相当比例（50%）的冠状动脉实现了再灌注。需要进行比较研究，以严格比较局部或全身治疗后的血管造影结果，并评估再灌注对可能降低长期发病率和死亡率的影响。尽管冠状动脉内治疗似乎对诱导再灌注更有效，但静脉治疗可能具有更大的临床影响，因为它可以在症状出现后更快实施，且不需要专门的心脏导管插入设备。
