White H D, Cross D B, Elliott J M, Norris R M, Yee T W
Cardiovascular Research, Green Lane Hospital, Auckland, New Zealand.
Circulation. 1994 Jan;89(1):61-7. doi: 10.1161/01.cir.89.1.61.
After thrombolytic therapy, long-term patency of the infarct-related artery may reduce arrhythmias, limit ventricular dilatation, and provide collaterals to another infarct zone if further infarction occurs. However, independent long-term prognostic value of infarct artery patency has not been shown.
We followed 312 patients with first myocardial infarction treated < 4 hours after pain onset with thrombolysis (streptokinase [n = 188] or recombinant tissue-type plasminogen activator [n = 124]). At 28 +/- 11 days, cardiac catheterization was performed. Flow of the infarct-related artery was assessed by the TIMI scoring system, and a scoring system relating coronary stenoses and flow to the amount of myocardium supplied was also used. Follow-up was for 39 +/- 13 months. Cardiac death occurred in 5.8% of patients, and there were two noncardiac deaths. Revascularization was performed in 11.5% of patients. On univariate and multivariate analysis, ventricular function (ejection fraction, P = .006 and .02, or end-systolic volume index, P = .01 and .06) was the most important prognostic factor. Patency of the infarct-related artery measured as TIMI 3 flow was marginally significant on univariate analysis (P = .08) but not on multivariate analysis (P = .2). Patency was an independent prognostic factor in univariate and multivariate analysis when measured as an occlusion score (amount of myocardium supplied by an occluded artery, P = .01 and < .05). When the ejection fraction was > or = 50%, only occluded arteries supplying > 25% of the left ventricle affected prognosis adversely. If the ejection fraction was < 50%, occluded arteries supplying < 25% of myocardium also adversely affected prognosis. Treadmill exercise duration 4 weeks after infarction was the only other prognostic factor identified.
Ventricular function and infarct-related artery patency are independent prognostic factors after thrombolytic therapy for acute myocardial infarction.
溶栓治疗后，梗死相关动脉的长期通畅可能会减少心律失常、限制心室扩张，并在再次发生梗死时为另一梗死区域提供侧支循环。然而，梗死动脉通畅的独立长期预后价值尚未得到证实。
我们对312例疼痛发作后4小时内接受溶栓治疗（链激酶[n = 188]或重组组织型纤溶酶原激活剂[n = 124]）的首次心肌梗死患者进行了随访。在28±11天时进行了心导管检查。通过TIMI评分系统评估梗死相关动脉的血流情况，同时还使用了一种将冠状动脉狭窄和血流与所供应心肌量相关联的评分系统。随访时间为39±13个月。5.8%的患者发生心源性死亡，另有2例非心源性死亡。11.5%的患者接受了血运重建治疗。在单因素和多因素分析中，心室功能（射血分数，P = .006和.02，或收缩末期容积指数，P = .01和.06）是最重要的预后因素。以TIMI 3级血流衡量的梗死相关动脉通畅情况在单因素分析中具有边缘显著性（P = .08），但在多因素分析中不显著（P = .2）。以闭塞评分（闭塞动脉所供应的心肌量）衡量时，通畅情况在单因素和多因素分析中均为独立的预后因素（P = .01和<.05）。当射血分数≥50%时，仅供应左心室>25%的闭塞动脉对预后有不良影响。如果射血分数<50%，供应心肌<25%的闭塞动脉也会对预后产生不良影响。梗死4周后的平板运动持续时间是唯一确定的其他预后因素。
心室功能和梗死相关动脉通畅情况是急性心肌梗死溶栓治疗后的独立预后因素。
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