Stone G W, Grines C L, Browne K F, Marco J, Rothbaum D, O'Keefe J, Hartzler G O, Overlie P, Donohue B, Chelliah N, Vlietstra R, Puchrowicz-Ochocki S, O'Neill W W
Cardiovascular Institute, El Camino Hospital, Mountain View, California 94040, USA.
Am J Cardiol. 1996 Jul 1;78(1):19-25. doi: 10.1016/s0002-9149(96)00220-2.
In the Primary Angioplasty in Myocardial Infarction trial, 395 patients with acute myocardial infarction (AMI) were prospectively randomized to tissue plasminogen activator (tPA) or primary percutaneous transluminal coronary angioplasty (PTCA). In 138 patients with anterior wall AMI, in-hospital mortality was significantly reduced by treatment with PTCA compared with tPA (1.4% vs 11.9%, p = 0.01). PTCA also resulted in lower rates of death or reinfarction (1.4% vs 18.0%, p = 0.0009), recurrent myocardial ischemia (11.3% vs 28.4%, p = 0.01), and stroke (0.0% vs 6.0%, p = 0.037) in anterior wall AMI. The independent beneficial effect of treatment with primary PTCA rather than tPA in anterior wall AMI was confirmed by multivariate analysis and interaction testing. The in-hospital mortality of 257 patients with nonanterior wall AMI was similar after PTCA and tPA (3.2% vs 3.8%, p = 0.82). Compared with tPA, however, primary PTCA resulted in a markedly lower rate of recurrent myocardial ischemia (9.7% vs 27.8%, p = 0.0002), fewer unscheduled catheterization and revascularization procedures, and a shorter hospital stay (7.0 vs 8.6 days, p = 0.01) in nonanterior wall AMI. Thus, compared with tPA, primary PTCA in patients with anterior wall AMI results in significantly improved survival, with lower rates of stroke, reinfarction, and recurrent myocardial ischemia. In nonanterior wall AMI, treatment with PTCA and tPA results in similar early mortality, although PTCA-treated patients have a more stable hospital course characterized by reduced recurrent ischemia, fewer subsequent invasive procedures, and earlier discharge.
在心肌梗死的直接血管成形术试验中，395例急性心肌梗死（AMI）患者被前瞻性随机分为接受组织型纤溶酶原激活剂（tPA）或直接经皮腔内冠状动脉血管成形术（PTCA）治疗。在138例前壁AMI患者中，与tPA治疗相比，PTCA治疗使住院死亡率显著降低（1.4%对11.9%，p = 0.01）。PTCA治疗还使前壁AMI患者的死亡或再梗死发生率降低（1.4%对18.0%，p = 0.0009），复发性心肌缺血发生率降低（11.3%对28.4%，p = 0.01），以及卒中发生率降低（0.0%对6.0%，p = 0.037）。多因素分析和交互作用检验证实了在前壁AMI中直接PTCA治疗而非tPA治疗具有独立的有益效果。257例非前壁AMI患者接受PTCA和tPA治疗后的住院死亡率相似（3.2%对3.8%，p = 0.82）。然而，与tPA相比，直接PTCA使非前壁AMI患者的复发性心肌缺血发生率显著降低（9.7%对27.8%，p = 0.0002），非计划的导管插入术和血管重建术减少，住院时间缩短（7.0天对8.6天，p = 0.01）。因此，与tPA相比，前壁AMI患者接受直接PTCA可显著提高生存率，降低卒中、再梗死和复发性心肌缺血的发生率。在非前壁AMI中，PTCA和tPA治疗导致的早期死亡率相似，尽管接受PTCA治疗的患者住院过程更稳定，其特点是复发性缺血减少、后续侵入性操作减少且出院更早。
