Gil V M, Ventosa A, Antunes A F, Morais J, Seabra-Gomes R
Instituto do Coração, Carnaxide.
Rev Port Cardiol. 1996 May;15(5):413-20, 366.
Late thrombolytic treatment (after 6 hours from pain onset) for acute myocardial infarction has been shown to improve survival in a cohort of patients. The mechanisms underlying such benefit have been debated and a controversy exists about the influence of late thrombolysis over left ventricular function as one potential mechanism. The present study intended to clarify the effects of late thrombolysis with alteplase on left ventricular function parameters.
Prospective, multicenter, randomised, double-blind study. Ancillary study to LATE trial.
We studied 103 patients, 81.6% men, randomly allocated to alteplase (100 mg over 3 hours) or placebo 6 to 24 hours after onset of myocardial infarction.
Left ventricular function parameters by radionuclide ventriculography were evaluated at 1 and 6 months after myocardial infarction.
At 1 month, left ventricular ejection fraction was 48.86% on alteplase and 43.19% in placebo group (p = 0.028), with greater benefits for septal and apical regions. At 6 months no significant differences were found.
Those data suggest that late thrombolysis with alteplase improves left ventricular function 1 month after myocardial infarction although the difference did not persist at 6 months. Improvement of left ventricular function shall, therefore, be considered as one of the possible mechanisms underlying the benefit of late thrombolysis.
急性心肌梗死后的晚期溶栓治疗（疼痛发作6小时后）已被证实在一组患者中可提高生存率。这种获益背后的机制一直存在争议，晚期溶栓对左心室功能的影响作为一种潜在机制也存在争议。本研究旨在阐明阿替普酶晚期溶栓对左心室功能参数的影响。
前瞻性、多中心、随机、双盲研究。LATE试验的辅助研究。
我们研究了103例患者，男性占81.6%，在心肌梗死发作后6至24小时随机分配接受阿替普酶（3小时内100毫克）或安慰剂治疗。
在心肌梗死后1个月和6个月通过放射性核素心室造影评估左心室功能参数。
1个月时，阿替普酶组左心室射血分数为48.86%，安慰剂组为43.19%（p = 0.028），对室间隔和心尖区域的益处更大。6个月时未发现显著差异。
这些数据表明，阿替普酶晚期溶栓可改善心肌梗死后1个月的左心室功能，尽管这种差异在6个月时未持续存在。因此，左心室功能的改善应被视为晚期溶栓获益的可能机制之一。
