Simoons M L
Thoraxcenter, University Hospital Rotterdam, The Netherlands.
Cardiol Clin. 1995 Aug;13(3):339-45.
In larger trials the relative reduction in mortality rates brought about by thrombolytic therapy is similar among various subgroups. Accordingly, the absolute mortality reduction by thrombolytic therapy is largest in patients with the greatest expected mortality in the placebo groups. Similarly, the additional benefit by accelerated tissue plasminogen activator (TPA) is proportional to the expected mortality without thrombolytic therapy. Using logistic regression analysis a table has been developed predicting the survival benefit from thrombolytic therapy in groups of patients with different baseline characteristics. A table also has been developed to predict the risk of intracranial hemorrhage from thrombolytic therapy. Using these two tables, an individual risk/benefit assessment can be made. In most patients the benefits of thrombolytic therapy far exceed the risk of intracranial hemorrhage. Similarly, the advantage of more intensive therapy (accelerated TPA) exceeds the slightly increased bleeding risk. The model presented can help to allocate different modes of reperfusion therapy to individual patients, accounting for limited resources.
在规模更大的试验中，溶栓治疗带来的死亡率相对降低在各个亚组中相似。因此，溶栓治疗使死亡率的绝对降低在安慰剂组中预期死亡率最高的患者中最为显著。同样，加速组织型纤溶酶原激活剂（TPA）带来的额外益处与无溶栓治疗时的预期死亡率成正比。通过逻辑回归分析，已制定出一个表格，用于预测不同基线特征患者群体接受溶栓治疗后的生存获益。还制定了一个表格来预测溶栓治疗导致颅内出血的风险。使用这两个表格，可以进行个体风险/获益评估。在大多数患者中，溶栓治疗的益处远远超过颅内出血的风险。同样，强化治疗（加速TPA）的优势超过了轻微增加的出血风险。所呈现的模型有助于将不同的再灌注治疗模式分配给个体患者，同时考虑到资源有限的情况。
