Cordioli E, Muscari A, Pizzi C, Zacà F, Tondini C, Premuda G, Puddu P
Istituto di Patologia Speciale Medica e Metodologia Clinica, Università degli Studi, Bologna.
Cardiologia. 1994 Jun;39(6):391-9.
Although the efficacy of intravenous thrombolysis in the treatment of acute myocardial infarction has been widely proved, some uncertainty concerning the "temporal window" of administration still persists. The aim of the present investigation was to study whether the late administration of a thrombolytic agent (6 or more hours after the onset of symptoms of acute myocardial infarction) offers any short or long-term advantages with regards to left ventricular function and clinical outcome. We studied 100 consecutive patients at their first episode of myocardial infarction, admitted to Coronary Unit within 24 hours of the onset of symptoms. Of these patients, 62 were administered rt-PA (44 patients within the 6th hour, and 18 between the 6th and 24th hour after the onset of symptoms) and the 38 remaining patients, who did not receive the thrombolytic agent (due to concerns with respect to possible complications), constituted the control group (18 admitted within 6 hours and 20 between 6 and 24 hours). All patients underwent serial electrocardiograms, and echocardiograms upon admission and at discharge to assess the ejection fraction, the asynergy score and the percentage of ischemic area. Furthermore, the survivors were invited for a follow-up examination one year after their acute initial episode. Seven cases of heart failure occurred, before discharge, among the control patients admitted 6 to 24 hours after onset of symptoms, compared with no cases in the subgroup of patients treated with rt-PA during the same time period (p = 0.0068).(ABSTRACT TRUNCATED AT 250 WORDS)
尽管静脉溶栓治疗急性心肌梗死的疗效已得到广泛证实，但在给药的“时间窗”方面仍存在一些不确定性。本研究的目的是探讨在急性心肌梗死症状发作6小时或更久后)延迟给予溶栓剂是否在左心室功能和临床结局方面具有短期或长期优势。我们研究了100例首次发生心肌梗死且在症状发作24小时内入住冠心病监护病房的连续患者。在这些患者中，62例接受了重组组织型纤溶酶原激活剂(rt-PA)治疗(44例在症状发作后6小时内给药，18例在症状发作后6至24小时给药)，其余38例患者(因担心可能出现并发症)未接受溶栓剂治疗，构成对照组(18例在6小时内入院，20例在6至24小时内入院)。所有患者入院时和出院时均接受系列心电图检查和超声心动图检查，以评估射血分数、运动不协调评分和缺血面积百分比。此外，幸存者在急性发作后一年被邀请进行随访检查。在症状发作后6至24小时入院的对照组患者中，有7例在出院前发生心力衰竭，而在同一时期接受rt-PA治疗的亚组患者中无此情况发生(p = 0.0068)。(摘要截短至250字)
