Klugmann S, Della Grazia E, Maras P, Medugno G, Pandullo C, Salvi A, Camerini F
G Ital Cardiol. 1983;13(4):353-6.
Pharmacologic myocardial reperfusion is a new strategy in the treatment of acute myocardial infarction, but its widespread use has raised several problems which are still unsolved. The time limit from the onset of ischemic pain until the beginning of thrombolysis is undefined yet. Experimental and clinical observations set this time within three hours. A reopened vessel is still at risk for reocclusion and anticoagulants are not always effective in the prevention of this. It is likely therefore that pharmacologic thrombolysis is only one step in the process of myocardial salvage and that other techniques like transluminal coronary angioplasty and/or coronary bypass surgery, should follow shortly. Intracoronary thrombolysis does not carry an increased risk for acute myocardial infarction patients. However haemorrhagic complications are expected to occur in less than 6% of cases during their hospital stay. To evaluate the extent of myocardial salvage quantitative ventriculography and intracoronary thallium 201 scintigraphy represent the most reliable techniques. Only the results of the continuing randomized trials will clarify the efficacy of this new way of therapy for morbidity, mortality and myocardial salvage.
药物性心肌再灌注是治疗急性心肌梗死的一种新策略，但其广泛应用引发了一些尚未解决的问题。从缺血性疼痛发作到溶栓开始的时间限制尚未明确。实验和临床观察将这段时间设定在三小时内。重新开通的血管仍有再次闭塞的风险，而抗凝剂在预防这一情况时并不总是有效。因此，药物溶栓可能只是心肌挽救过程中的一步，其他技术如经皮腔内冠状动脉成形术和/或冠状动脉搭桥手术可能应随后进行。冠状动脉内溶栓对急性心肌梗死患者而言并不会增加风险。然而，预计在住院期间不到6%的病例会出现出血并发症。为评估心肌挽救的程度，定量心室造影和冠状动脉内铊201闪烁显像代表了最可靠的技术。只有正在进行的随机试验结果才能阐明这种新治疗方法对发病率、死亡率和心肌挽救的疗效。
