Chatterjee S S, Bhattacharya R, Das Biswas A, Ghosh S, Ghosh S P, Biswas P K, Biswas A, Chowdhury D, Maity A K
Institute of Post Graduate Medical Education & Research, Calcutta.
Indian Heart J. 1993 Mar-Apr;45(2):103-8.
One hundred consecutive age and sex-matched patients of 3 different subsets of unstable angina (recent onset angina -65, crescendo angina -20, post-infarct angina-15) were randomized 1:1 after coronary angiography to receive I.V., either 1.5 x 10(6) units of streptokinase (SK) in 200 ml of normal saline or 200 ml of normal saline alone (control) in 1 hour. Repeat angiography was done in those patients having intra-coronary thrombi (37.3%) during the initial angiography. Both groups received optimal doses of heparin followed by warfarin, aspirin and other standard drugs and were followed up for 6 months. Anginal pain subsided significantly in the SK group-41 (82%) vs 25 (50%) (P < 0.005), especially in patients with recent onset angina (92.5% vs 60%, P < 0.005). Incidence of acute myocardial infarction (AMI) was much less in the SKgp (4(8%) vs 17 (34%) (p < 0.05). Four cases of fatal MI and four cases of sudden cardiac death (SCD) occurred in the control group against none in the SKgp. Requirements of mechanical revascularization was significantly less (P < 0.05) in the SK gp. Angiographic evidence of partial or complete clot lysis was noted in 90% of SK gp. vs 4.8% of control (P < 0.01). Echocardiographically assessed LV function improved significantly with SK-therapy in recent onset (P < 0.05) and crescendo angina (P < 0.001) subsets--however, the improvements in post infarct angina subset were not statistically significant. The beneficial outcome with SK therapy was observed in patients irrespective of angiographic evidence of thrombi.(ABSTRACT TRUNCATED AT 250 WORDS)
选取100例年龄和性别匹配的不稳定型心绞痛患者，分为3个不同亚组（初发型心绞痛65例、恶化型心绞痛20例、梗死后心绞痛15例），在冠状动脉造影后按1:1随机分组，1小时内静脉注射1.5×10⁶单位链激酶（SK）溶于200ml生理盐水中，或仅注射200ml生理盐水（对照组）。对初次血管造影时有冠状动脉内血栓形成的患者（37.3%）进行重复血管造影。两组均给予最佳剂量肝素，随后给予华法林、阿司匹林和其他标准药物，并随访6个月。SK组心绞痛明显缓解的患者有41例（82%），而对照组为25例（50%）（P<0.005），尤其是初发型心绞痛患者（92.5%对60%，P<0.005）。SK组急性心肌梗死（AMI）发生率明显较低（4例（8%）对17例（34%），P<0.05）。对照组发生4例致命性心肌梗死和4例心源性猝死，而SK组无。SK组机械性血运重建需求明显较少（P<0.05）。SK组90%有部分或完全血栓溶解的血管造影证据，而对照组为4.8%（P<0.01）。超声心动图评估显示，SK治疗使初发型心绞痛（P<0.05）和恶化型心绞痛（P<0.001）亚组的左心室功能明显改善，然而梗死后心绞痛亚组的改善无统计学意义。无论有无血栓的血管造影证据，SK治疗均显示有益结果。（摘要截断于250字）
