直接血管成形术在急性心肌梗死中相对于溶栓治疗的长期疗效

标　　题　直接血管成形术在急性心肌梗死中相对于溶栓治疗的长期疗效作　　者　ＺｉｊｌｓｔｒａＦ ,ＨｏｏｒｎｔｊｅＪＣＡ ,ＤｅＢｏｅｒＭ Ｊ等　　来　　源　新英格兰医学杂志 ,1999,341:14 13～14 19疾　　病　急性心肌梗死目　　的　比较急性心肌梗死患者接受溶栓治疗与直接血管成形术的长期疗效。设　　计　前瞻性、随机、多中心。患　　者　 395例急性心肌梗死患者。 194例接受直接血管成形术 ,2 0 1例接受链激酶治疗。随　　访　 5年± 2年治疗方案　直接血管成形术或链激酶治疗 (1ｈ内静滴 15 0万Ｕ)辅助治疗　所有患者均接受阿…     

TAMI心肌梗死的溶栓治疗和血管成形术

标　　题　急性心肌梗死患者静脉组织纤溶酶原激活剂后行即刻延迟选择性血管成形术的随机试验。作　　者　ＴｏｐｏｌＥＪ ,ＣａｌｉｆｆＲＭ ,ＧｅｏｒｇｅＢＳ ,ｅｔａｌ　　参考文献　ＮＥｎｇｌＪＭｅｄ ,1987,3 71:5 81～ 5 88　　疾　　病　急性心肌梗死。目　　的　为了比较急性心肌梗死患者经组织型纤溶酶原激活剂静脉溶栓进行即刻或延迟 (7～ 10ｄ)冠状动脉成形术的疗效。设　　计　随机 ,公开 ,多中心。病　　例　 3 86例 ,年龄≤ 75岁 ,出现急性心肌梗死症状 <4ｈ(如果存在严重进行性胸痛则 <6ｈ) ,2个导联ＳＴ段抬高≥ 1ｍｍ。…     

急性心肌梗死患者的直接经皮腔内冠状动脉成形术与溶栓治疗疗效比较

为探讨急性心肌梗死直接经皮腔内冠状动脉成形术的安全性及临床疗效 ,选择 6 2例未经静脉和冠状动脉内溶栓治疗的急性心肌梗死患者 ,在紧急冠状动脉造影后即行直接经皮腔内冠状动脉成形术 ;另外选择 5 9例急性心肌梗死患者 ,采用溶栓治疗 ,溶栓治疗后不再接受介入治疗和外科冠状动脉搭桥 ,然后比较直接经皮腔内冠状动脉成形术和溶栓治疗的疗效、安全性及预后。结果发现 ,直接经皮腔内冠状动脉成形术组 6 0例再灌注成功 ,成功率为 96 .7% ,其中 4例合并心源性休克的患者均再灌注成功 ,血压回升 ,急性上消化道出血 1例 ,死亡率为 0 ;溶栓治疗组 38例再灌注成功 ,成功率为 6 4 .4 % ,住院期间死亡 5例 ,出院 6月内死亡 2例 ,急性上消化道出血 1例 ,血尿 1例 ,溶栓治疗后心源性休克 5例 ,死亡率为 1 1 .9%。直接经皮腔内冠状动脉成形术再灌注成功率明显高于溶栓治疗 ,死亡率和主要心脏事件的发生率明显低于溶栓治疗 (P <0 .0 1 )。结果提示 ,急性心肌梗死的直接经皮腔内冠状动脉成形术治疗安全有效 ,再灌注成功率明显高于溶栓治疗 ,疗效及预后优于溶栓治疗     

老年人急性心肌梗死行直接冠状动脉介入治疗术与溶栓治疗的比较

急性心肌梗死后尽早恢复梗死相关动脉的再灌注是治疗中的首要问题。近20年来直接冠状动脉(冠脉)介入治疗的应用明显降低了急性心肌梗死患者的病死率,改善了患者的预后。我们研究目的在于比较老年急性心肌梗死患者行直接经皮冠脉介入治疗术与经静脉溶栓治疗的疗效。 一、资料与方法 1.对象与分组:自1997年10月至2002年9月因急性心肌梗死收住我院心内科监护病房的老年患者共318例。其中116例接受静脉溶栓治疗(溶栓治疗组),患者年龄60     

急性广泛前壁心梗尿激酶溶栓后心电图恢复1例

患者男 ,46岁 ,有吸烟及高血压病史。于 2 0 0 1年 12月 4日睡眠中突发心前区不适、伴胸疼、心慌、以心绞痛收住院。入院时心电图正常 ,入院后 6ｈ在大便过程中胸疼加剧、大汗淋漓、痛苦面容。体检 :ＢＰ 12 0 80ｍｍＨｇ、心率 90次 ｍｉｎ、律齐、各瓣膜未闻及杂音。急查心电图示 :Ｖ1 ～Ｖ4的ＳＴ段抬高 ,Ｔ波高耸 ,急性广泛前壁心肌梗死。速用尿激酶 2 0 0万Ｕ静脉溶栓、辅以低分子肝素钙、巴米尔。溶栓过程中心电监护出现心律失常 (偶发室性早搏、房性早搏 ) ,胸痛消失。溶栓结束后心电图示 :Ｖ1 ～Ｖ3的ＳＴ段下降达到 5 0 % ,Ｖ4的…     

前壁及下壁急性心肌梗死并发心律失常比较分析

目的:比较分析前壁及下壁急性心肌梗死(AMI)后并发心律失常的类型。方法:收集了186例急性心肌梗死患者梗塞后出现的各种心律失常的类型,并作统计分析。结果:①前壁心梗后窦速和室内传导阻滞发生率显著高于下壁心梗(P分别<0.05,<0.01),而下壁心梗后窦缓及房室传导阻滞发生率显著高于前壁心梗(P均<0.01)。②下壁心梗并发房性及室性异位节律(未包括室颤)均显著高于前壁心梗(P均<0.05)。结论:前壁心梗及下壁心梗并发心律失常的类型有差别:前者以窦速和室内传导阻滞较常见,后者以窦缓、房室传导阻滞及房室异位心律常见。     

急性心肌梗死急诊介入治疗与溶栓治疗的疗效比较

目的比较急性ST段抬高性心肌梗死(STEMI)患者分别接受直接经皮冠状动脉介入(PCI)治疗和溶栓治疗住院及随访期间的临床疗效差别。方法108例STEMI患者,66例行直接PCI治疗(PCI组),42例行溶栓治疗(UK组)。比较2组梗死相关动脉(IRA)再通率、左室功能指标、病死率及主要心血管事件发生率的差别。结果PCI组IRA开通率高于UK组(P<0.01),住院病死率低于UK组(P<0.05),左室功能指标优于UK组(左室射血分数更高、左室舒张末径较小、室壁运动障碍率较低,P<0.05)。随访期间比较PCI组再次血运重建率低于UK组(P<0.01),心血管病死率低于UK组(P<0.05)。结论与溶栓治疗相比,PCI治疗能及时有效地开通梗死相关血管,改善左室功能,降低病死率和再次血运重建率。     

急性下壁心肌梗死伴胸前导联ST段抬高患者溶栓与直接PTCA的比较——随机试验的即刻及长期疗效

题　　目　急性下壁心肌梗死伴胸前导联ＳＴ段抬高患者溶栓与直接ＰＴＣＡ的比较———随机研究的即刻及长期疗效作　　者　ＲｉｂｉｃｈｉｎｉＦ ,ＳｔｅｆｆｅｎｉｎｏＧ ,ＤｅｌｌａｖａｌｌｅＡ ,ｅｔａｌ.　　资料来源　ＪＡｍＣｏｌｌＣａｒｄｉｏｌ,1998,32 :16 87～ 16 94研究疾病　急性心肌梗死研究目的　比较直接ＰＴＣＡ与ｒｔ ＰＡ对急性下壁心肌梗死患者的疗效。研究设计　单中心随机试验。病例选择　发病后 6ｈ内的急性下壁心肌梗死患者 110例 ,至少 2个下壁导联ＳＴ段抬高伴至少 3个胸前导联ＳＴ段压低。随　　访　 1年。治…     

直接PTCA与溶栓治疗急性心肌梗死的疗效探讨

急性心肌梗死 (ＡＭＩ)时 ,选择溶栓治疗还是直接经皮腔内冠状动脉成形术 (ＰＴＣＡ)治疗 ,2 0 0 0年美国心脏协会科学会议对下面几个问题进行了讨论。1　直接ＰＴＣＡ降低ＡＭＩ患者游离壁破裂的危险游离壁破裂是ＡＭＩ的严重并发症 ,并且是导致院内死亡的第二原因 ,游离壁破裂是由于电、机械分离而导致的猝死。在超声心动图上表现为大量的心包积液或在外科修补术和尸检中证明有游离壁破裂。Ｄｏｒｅｎｏ在他的院内调查中评估比较了ＡＭＩ并发游离壁破裂采用直接ＰＴＣＡ和溶栓治疗的效果 ,有 1375例发病12小时以内的ＡＭＩ患者 ,溶栓治疗…     

心肌梗死溶栓治疗试验(2期A)

标　　题　ａ .急性心肌梗死患者溶栓治疗后即可及延迟心导管检查及血管成形术。ＴＩＭＩⅡ Ａ的结果。ｂ .组织型纤溶酶原激活剂溶栓后 ,即刻侵入性 ,延迟侵入性及保密治疗的比较。ＴＩＭＩ Ⅱ Ａ的结果。作　　者　ａ .ＴＩＭＩ研究组　ｂ .ＲｏｇｅｒｓＷＪ ,ＢａｉｍＤＳ ,ＧｏｒｅＪＭ ,ｅｔａｌ　　参考文献　ＪＡＭＡ ,1988,2 60 :2 849～ 2 85 8;Ｃｉｒｕｌａｔｉｏｎ ,1990 ,81:145 7～ 1476　　疾　　病　急性心肌梗死。目　　的　比较急性心肌梗死溶栓治疗后 ,即可侵入性 ,延迟侵入性 (18～48ｈ)及保守治疗的冠脉造影结果。设…     

Primary angioplasty versus systemic thrombolysis in anterior myocardial infarction

OBJECTIVES: This study compares the efficacy of primary angioplasty and systemic thrombolysis with t-PA in reducing the in-hospital mortality of patients with anterior AMI. BACKGROUND: Controversy still exists about the relative benefit of primary angioplasty over thrombolysis as treatment for AMI. METHODS: Two-hundred and twenty patients with anterior AMI were randomly assigned in our institution to primary angioplasty (109 patients) or systemic thrombolysis with accelerated t-PA (111 patients) within the first five hours from the onset of symptoms. RESULTS: Baseline characteristics were similar in both groups. Primary angioplasty was independently associated with a lower in-hospital mortality (2.8% vs. 10.8%, p = 0.02, adjusted odds ratio 0.23, 95% confidence interval 0.06 to 0.85). During hospitalization, patients treated by angioplasty had a lower frequency of postinfarction angina or positive stress test (11.9% vs. 25.2%, p = 0.01) and less frequently underwent percutaneous or surgical revascularization after the initial treatment (22.0% vs. 47.7%, p < 0.001) than did patients treated by t-PA. At six month follow-up, patients treated by angioplasty had a lower cumulative rate of death (4.6% vs. 11.7%, p = 0.05) and revascularization (31.2% vs. 55.9%, p < 0.001) than those treated by t-PA. CONCLUSIONS: In centers with an experienced and readily available interventional team, primary angioplasty is superior to t-PA for the treatment of anterior AMI.     

Primary angioplasty and thrombolysis are both reasonable options in acute myocardial infarction

Primary angioplasty is increasingly being advocated as the preferred approach for treating acute ST-segment elevation myocardial infarction regardless of whether interinstitutional transfer is required. This review critically analyzes the evidence comparing primary angioplasty with thrombolytic therapy and concludes that reasonable health care professionals may still find considerable uncertainty about the superiority of primary angioplasty for all situations. The magnitude of benefit for primary angioplasty over thrombolysis is probably less than 1 to 2 lives saved/100 patients treated and largely depends on the choice of thrombolytic agent, time to treatment, place of treatment, and adjunctive therapy. There is little evidence that systematically transferring patients for primary angioplasty in routine practice will provide any health benefits over thrombolysis. Consequently, it may be most useful to view these treatments as complementary rather than competitive. Thrombolysis remains a clinically and economically attractive option for the treatment of acute myocardial infarction that does not require the radical restructuring of our health care systems.     

Primary angioplasty and thrombolysis for acute myocardial infarction: An evidence summary

Coronary angioplasty is being increasingly used as the primary treatment for patients with acute myocardial infarction, but controversy remains over its potential adoption in preference to thrombolysis as standard care. This report summarizes the published evidence on health outcomes after primary angioplasty compared with thrombolysis or no intervention for patients with acute myocardial infarction. The data tables presented provide the scientific groundwork to assist physicians and other policy-makers in deciding which interventions to provide for broad populations of patients.     

Primary angioplasty reduces risk of myocardial rupture compared to thrombolysis for acute myocardial infarction

Although the mechanical complications of acute ventricular septal defect and acute mitral regurgitation are uncommon after acute myocardial infarction, these complications are associated with an extremely high morbidity and mortality. We hypothesized that the administration of thrombolytic drugs may result in hemorrhagic infarction as well as the potential for incomplete revascularization and thus may lead to an increased incidence of mechanical complications compared to primary angioplasty. Accordingly, we reviewed the data of the most contemporary thrombolytic and primary angioplasty trials and compared the incidence of mechanical complications among 36,303 patients treated with thrombolytics reported in the GUSTO trial to the incidence of mechanical complications among 1,295 patients treated with primary angioplasty obtained from the PAMI-1 and PAMI-2 trials. We found that angioplasty resulted in an overall 86% relative risk reduction in mechanical complications (2.20% vs. 0.31%, P < 0.001). In comparison to thrombolytic therapy, angioplasty resulted in an 82% decrease in acute mitral regurgitation (1.73% vs. 0.31%, P < 0.001) and a 100% decrease in acute ventricular septal defect (0.47% vs. 0.00%, P < 0.03). In conclusion, in patients with acute myocardial infarction, reperfusion with primary angioplasty is associated with less myocardial rupture and mechanical complications than thrombolytics. This finding may, in part, explain the improved prognosis observed in myocardial infarction patients treated with primary angioplasty. Cathet. Cardiovasc. Diagn. 42:151–157, 1997. © 1997 Wiley-Liss, Inc.     

Emergency angioplasty in acute anterior myocardial infarction

Ninety-three patients with acute anterior myocardial infarction were treated with emergency percutaneous transluminal coronary angioplasty (PTCA). All were found to have a high-grade obstruction in the left anterior descending (LAD) vessel or the bypass graft to this vessel; 64 patients had a total occlusion. A completely successful PTCA, defined as a residual lesion of less than or equal to 50%, was achieved in 73 (78%) patients. A partially successful PTCA, with a residual lesion of 51% to 99%, was achieved in 12 (13%) patients. PTCA was unsuccessful in eight (9%) patients. Hospital mortality was 14%. Three parameters viewed separately each predicted hospital mortality: presence of shock, a proximal location of the LAD vessel occlusion, and the residual stenosis after PTCA. Reocclusion was found in only 11% of patients but 34% had evidence of restenosis on restudy.     

直接冠状动脉腔内成形术治疗急性心肌梗死

急性心肌梗死近年来大规模地推广应用静脉溶栓治疗,抢救了不少生命。直接经皮冠状动脉腔内成形术(PTCA)在急性心肌梗死的治疗上将又是一项有效的治疗措施。我科1995年8月～1998年4月,对46例急性心肌梗死病人作直接FTCA,取得满意临床效果。