Lincoff A M, Topol E J, Califf R M, Sigmon K N, Lee K L, Ohman E M, Rosenschein U, Ellis S G
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Cardiol. 1995 May 1;75(14):871-6. doi: 10.1016/s0002-9149(99)80678-x.
To determine whether pharmacologic reperfusion to Thrombolysis in Myocardial Infarction (TIMI) grade 2 flow during acute myocardial infarction confers the same clinical benefit as restoration of TIMI 3 flow, in-hospital clinical and angiographic outcomes in 1,229 patients prospectively enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction trials were analyzed. Patients were treated with intravenous tissue plasminogen activator or urokinase, or both. Angiography of the infarct-related artery 90 minutes after initiation of thrombolytic therapy demonstrated TIMI grades 0, 1, 2, or 3 flow in 20%, 7%, 17%, and 55% of vessels, respectively. Rescue or adjunctive coronary angioplasty was performed in 80%, 27%, and 16% of patients with TIMI 0/1, 2, or 3 flow, respectively. Predischarge angiography was performed in 963 patients. A significant gradient of increasing mortality was seen in patients with lower TIMI flow (4.3%, 6.1%, and 10.1% with TIMI 3, 2, and 0/1 flow, respectively, p = 0.002). The incidence of congestive heart failure and recurrent ischemia was significantly higher in patients with TIMI 2 than with TIMI 3 perfusion (26% vs 19% for heart failure, p = 0.03; 23% vs 17% for recurrent ischemia, p = 0.05). Acute left ventricular ejection fraction and infarct zone regional wall motion were also significantly improved in patients with TIMI 3 than with TIMI 2 flow, with trends toward better improvement in global and regional function in the TIMI 3 group. These findings were not affected by the use of acute coronary angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
为了确定急性心肌梗死期间实现心肌梗死溶栓（TIMI）2级血流的药物再灌注是否与恢复TIMI 3级血流具有相同的临床获益，我们分析了1229例前瞻性纳入心肌梗死溶栓和血管成形术试验患者的院内临床和血管造影结果。患者接受静脉注射组织纤溶酶原激活剂或尿激酶，或两者联合治疗。溶栓治疗开始90分钟后对梗死相关动脉进行血管造影，结果显示TIMI 0级、1级、2级和3级血流的血管分别占20%、7%、17%和55%。TIMI 0/1级、2级和3级血流的患者分别有80%、27%和16%接受了补救性或辅助性冠状动脉血管成形术。963例患者进行了出院前血管造影。TIMI血流较低的患者死亡率呈显著递增梯度（TIMI 3级、2级和0/1级血流的患者死亡率分别为4.3%、6.1%和10.1%，p = 0.002）。TIMI 2级灌注的患者充血性心力衰竭和复发性缺血的发生率显著高于TIMI 3级灌注的患者（心力衰竭发生率分别为26%和19%，p = 0.03；复发性缺血发生率分别为23%和17%，p = 0.05）。与TIMI 2级血流的患者相比，TIMI 3级血流的患者急性左心室射血分数和梗死区室壁运动也有显著改善，TIMI 3组在整体和局部功能方面有更好改善的趋势。这些结果不受急性冠状动脉血管成形术使用的影响。（摘要截短至250字）
