Steg P G, Laperche T, Golmard J L, Juliard J M, Benamer H, Himbert D, Aubry P
Département de Cardiologie, CHU Bichat-Beaujon, Paris and Clichy, France.
J Am Coll Cardiol. 1998 Mar 15;31(4):776-9. doi: 10.1016/s0735-1097(98)00018-7.
We sought to examine the relation between time to treatment and 90-min patency rates in patients receiving intravenous streptokinase (SK) or accelerated tissue-type plasminogen activator (t-PA).
Early patency of the infarct-related artery is a major determinant of survival after thrombolysis for acute myocardial infarction. Some data suggest that time to treatment may influence the efficacy of nonfibrin-specific thrombolytic agents in restoring early patency of the infarct-related vessel.
We performed a retrospective analysis of a cohort of 481 patients receiving thrombolytic therapy for acute myocardial infarction <6 h after pain onset, all of whom underwent 90-min coronary angiography. Patency of the infarct-related artery was graded by two observers who had no knowledge of the treatment received or the time between pain and therapy.
There was no difference in baseline clinical or angiographic characteristics according to the timing or nature of treatment. Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3 patency rate after SK correlated negatively with the time between onset of pain and thrombolysis (r = 0.8, p = 0.05), whereas the 90-min patency rate after t-PA appeared stable as a function of time to treatment. When patients were categorized as having received treatment <3 or > or = 3 h after pain onset, the patency rate was similar with t-PA, but significantly higher when SK was administered early rather than late, regardless of whether TIMI flow grades 2 and 3 were pooled (86.9% vs. 59.4%, p = 0.0001) or TIMI flow grade 3 alone was considered to indicate patency (81.7% vs. 53.6%, p = 0.0001). Multivariate logistic regression analysis showed a negative effect of time to treatment on the patency probability for SK (p = 0.0001) but not for t-PA.
The efficacy of streptokinase but not t-PA in restoring early coronary patency after intravenous thrombolysis is markedly lower when patients are treated later after onset of pain.
我们试图研究接受静脉注射链激酶（SK）或加速型组织型纤溶酶原激活剂（t-PA）治疗的患者的治疗时间与90分钟血管通畅率之间的关系。
梗死相关动脉的早期通畅是急性心肌梗死溶栓治疗后生存的主要决定因素。一些数据表明，治疗时间可能会影响非纤维蛋白特异性溶栓药物恢复梗死相关血管早期通畅的疗效。
我们对一组481例在疼痛发作后<6小时接受急性心肌梗死溶栓治疗的患者进行了回顾性分析，所有患者均接受了90分钟冠状动脉造影。两名观察者对所接受的治疗或疼痛与治疗之间的时间不知情，对梗死相关动脉的通畅情况进行分级。
根据治疗时间或性质，基线临床或血管造影特征无差异。SK治疗后心肌梗死溶栓（TIMI）血流2级或3级通畅率与疼痛发作至溶栓的时间呈负相关（r = 0.8，p = 0.05），而t-PA治疗后90分钟通畅率随治疗时间的变化似乎保持稳定。当患者被分类为在疼痛发作后<3小时或≥3小时接受治疗时，t-PA的通畅率相似，但SK早期给药时的通畅率显著高于晚期给药，无论TIMI血流2级和3级是否合并（86.9%对59.4%，p = 0.0001）或仅考虑TIMI血流3级表示通畅（81.7%对53.6%，p = 0.0001）。多因素逻辑回归分析显示，治疗时间对SK的通畅概率有负面影响（p = 0.0001），但对t-PA没有影响。
疼痛发作后较晚治疗时，静脉溶栓后链激酶恢复早期冠状动脉通畅的疗效显著低于t-PA。
