Boissel J P, Castaigne A, Mercier C, Lion L, Leizorovicz A
Service de Pharmacologie Clinique, Lyon, France.
Eur Heart J. 1996 Feb;17(2):213-21. doi: 10.1093/oxfordjournals.eurheartj.a014837.
Reperfusion-induced ventricular fibrillation has been demonstrated in animal models of myocardial ischaemia, but no evidence exists for this in humans. The European Myocardial Infarction Project compared the efficacy and safety of pre-hospital thrombolytic therapy with that of hospital therapy. The objective of this study was to investigate the occurrence of reperfusion-induced ventricular fibrillation in acute myocardial infarction patients following thrombolytic therapy. In a double-blind multicentre trial, eligible patients were randomized to receive anistreplase at home followed by placebo in the hospital (A/P group), or placebo followed by anistreplase (P/A group). The occurrence of ventricular fibrillation, and other adverse events were recorded on specific study forms and could be attributed to defined time intervals. The incidence of ventricular fibrillation in the A/P group was significantly higher following the pre-hospital injection than in the P/A group (2.5% vs 1.6%; P = 0.021); the situation was reversed following the hospital injection (3.6% vs 5.3%; P = 0.002). No relationship was found between this excess of ventricular fibrillation and the patients' condition, with the exception of the site of the infarct. These results suggest the existence of reperfusion-induced ventricular fibrillation in patients developing myocardial infarction who receive thrombolytic treatment.
再灌注诱发的心室颤动已在心肌缺血的动物模型中得到证实，但在人类中尚无此类证据。欧洲心肌梗死项目比较了院前溶栓治疗与院内治疗的疗效和安全性。本研究的目的是调查溶栓治疗后急性心肌梗死患者中再灌注诱发的心室颤动的发生情况。在一项双盲多中心试验中，符合条件的患者被随机分为在家接受阿尼普酶治疗随后在医院接受安慰剂治疗（A/P组），或先接受安慰剂治疗随后接受阿尼普酶治疗（P/A组）。心室颤动及其他不良事件的发生情况记录在特定的研究表格上，并可归因于特定的时间间隔。A/P组院前注射后心室颤动的发生率显著高于P/A组（2.5%对1.6%；P = 0.021）；院内注射后情况则相反（3.6%对5.3%；P = 0.002）。除梗死部位外，未发现这种额外的心室颤动与患者病情之间存在关联。这些结果表明，接受溶栓治疗的心肌梗死患者中存在再灌注诱发的心室颤动。
