Vetrovec G W, Leinbach R C, Gold H K, Cowley M J
Am Heart J. 1982 Oct;104(4 Pt 2):946-52. doi: 10.1016/0002-8703(82)90268-x.
For an assessment of association of intracoronary thrombus with prolonged unstable myocardial ischemia and of the possible efficacy of local thrombolysis, 12 patients with recent prolonged unstable angina underwent 13 intracoronary streptokinase infusions. All patients had prolonged rest angina within 5 days of coronary angiography. Abnormal resting ECGs were present in all patients, and 10 had ECG changes referable to the ischemic-related vessel. There were seven native coronary and six bypass graft infusions with a mean streptokinase dose of 187,00 +/- 22,000 IU (standard error of mean). Angiographic findings consistent with intracoronary thrombus were identified in 11 of 13 ischemia-related vessels. Evidence of partial or complete intracoronary thrombolysis was noted angiographically in 10 of 13 ischemia-related vessels (77%), although reestablishment of anterograde flow was seen in only two of six totally or subtotally occluded vessels. Nine patients experienced rest angina during the 48 hours prior to infusion, whereas only three experienced angina during the 48 hours following infusion. In conclusion, angiographic findings before and after thrombolysis in this preliminary study demonstrate a high frequency of intracoronary thrombus in preinfarction syndromes. Furthermore, these limited observations suggest a decrease in angina frequency following thrombolytic therapy.
为评估冠状动脉内血栓与持续性不稳定型心肌缺血的相关性以及局部溶栓的可能疗效，12例近期有持续性不稳定型心绞痛的患者接受了13次冠状动脉内链激酶输注。所有患者在冠状动脉造影后5天内均有持续性静息性心绞痛。所有患者静息心电图均异常，10例有与缺血相关血管的心电图改变。共进行了7次自身冠状动脉和6次旁路移植血管输注，链激酶平均剂量为187,00±22,000国际单位（均值标准误）。在13支与缺血相关的血管中，有11支发现有与冠状动脉内血栓相符的血管造影表现。在13支与缺血相关的血管中，有10支（77%）在血管造影时发现有部分或完全冠状动脉内溶栓的证据，尽管在6支完全或次全闭塞的血管中只有2支恢复了前向血流。9例患者在输注前48小时内出现静息性心绞痛，而在输注后48小时内只有3例出现心绞痛。总之，在这项初步研究中，溶栓前后的血管造影结果显示，梗死前综合征中冠状动脉内血栓的发生率很高。此外，这些有限的观察结果表明溶栓治疗后心绞痛频率有所降低。
