TIMI 14(亚组研究)心肌梗死溶栓疗法14(亚组研究)

标题 阿昔单抗(abciximab)改善ST段抬高的心肌梗死(病人)心外膜血流和心肌再灌注:来自TIMI 14试验的观察结果。作者 DeLemos JA,Antman EM,Cibson CM,et al for the TIMI 14 investigators     

科素亚心肌梗死后生存研究(OPTIMAAL)

标　　题　科素亚心肌梗死后生存研究作　　者　ＤｉｃｋｓｔｅｉｎＫ ,ｅｔａｌ　　参考文献　ＡｍＪＣａｒｄｉｏｌ 1999(Ｉｎｐｒｅｓｓ)入选标准　 (1)急性心前区心梗或并发症状性或征兆性心衰的心梗病人。(2 )年龄≥ 5 0岁。　　该研究入选 5 0 0 0名病人 ,来自斯堪的那维亚半岛、英国以及德国的 30 0个研究中心。主要目标　评价科素亚或ＡＣＥＩ治疗对急性心梗后的高危病人总死亡率的影响。结　　果　目前正在进行中。科素亚心肌梗死后生存研究(OPTIMAAL)     

急性心肌梗死溶栓疗法对比研究(摘要)

急性心肌梗死溶栓疗法对比研究（摘要）牟瑞起杜明李克清魏雅萍王荣彬李愉荣王淑敏张建民刘平为探讨国产尿激酶（ｕｒｏｋｉｎａｓｅ，ＵＫ）、去纤酶（ｄｅ－ｆｒｉｎｕｍ）与进口链激酶（ｓｔｒｅｐｔｏｋｉｎａｓｅ）对急性心肌梗死（ＡＭＩ）溶栓治疗效果，我们于１...     

加拿大胺碘酮心肌梗死心律失常研究(CAMIAT)

心肌梗死后频发、反复期前去极化患者预后的随机研究     

心肌梗死直接血管成形、支架术研究(Stent-PAMI)

标　　题　急性心肌梗死中伴或不伴有支架植入的冠状动脉血管成形术作　　者　ＧｒｉｎｅｓＧＬ ,ＣｏｘＤＡ ,ＳｔｏｎｅＧＷ等　　来　　源　新英格兰医学杂志 ,1999,341:194 9～195 6疾　　病　急性心肌梗死目　　的　对急性心肌梗死患者行直接血管成形术 ,比较单纯球囊扩张与植入带肝素膜的Ｐａｌｍａｚ Ｓｃｈａｔｚ支架的效果。设　　计　随机、多中心。患　　者　共有 90 0例急性心肌梗死患者接受急诊心导管检查及血管成形术。随　　访　 6～ 6 5个月。治疗方案　将适合于支架植入的病变血管随机分为单纯球囊扩张术组 (ｎ =4 4 8)与…     

心肌梗死与心肌损伤(104)

近年来,出现了更为敏感与特异的心脏生物标志物的检测技术,以及更为敏感的心脏影像技术,这些新进展使小面积心肌梗死及心肌损伤都能被有效检出。此外,心肌梗死的各种治疗技术也取得显著提高,因而正确区分心肌梗死与心肌损伤有着重要临床意义。心肌梗死新定义自2000年起已先后三次被修订。[心肌梗死](1)诊断:心肌梗死可经临床与病理学两种方法诊断,而更为敏感,更特异的心脏生物标志物检测技术的问世,使两者更为接近,即原来只能经病理或尸检才能诊断的小面积心梗(面积<1%的心梗),     

(3) 急性心肌梗死介入治疗新概念

根据病理生理机制,急性心肌梗死(AMI)是由于冠状动脉(冠脉)粥样硬化斑块破裂后,在血小板激活和聚集的基础上有血栓形成,致冠脉急性闭塞的结果.因此,治疗AMI的关键是尽早实施冠脉血运重建术,迅速使闭塞的梗塞相关冠脉(IRCA)再通,恢复心肌梗死溶栓治疗临床试验(TIMI)3级血流和心肌灌注,才能挽救缺血心肌,缩小梗死面积,保护心室功能,从而改善AMI患者的近期和远期预后.目前,AMI冠脉血运重建的方法主要是溶栓疗法和经皮冠脉介入治疗(PCI).     

心肌梗死的电窗口(30)

<正>电窗口(Electrical Window)又称"窗口学说",是对心肌梗死后,面对心肌坏死区的探查电极记录到病理性Q波机制的一个解释。"窗口学说"认为,坏死心肌丧失除极功能时,将表现为病理性Q波和R波丧失,最终形成QS波形,即面对探查电极将记录到一个完全的负向波(图     

ADP-induced Platelet Aggregation and Metoprolol Treatment of Myocardial Infarction Patients

ABSTRACT The effect of metoprolol on platelet aggregation was investigated in a group of postmyocardial infarction (MI) patients. The study was double-blind and included 63 subjects; 30 patients were maintained on metoprolol and 33 received placebo treatment. Adenosine diphosphate (ADP)-induced platelet aggregation was carried out in each subject close to 4 weeks after the acute MI. It was demonstrated that metoprolol as compared to placebo did not influence ADP-induced platelet aggregation in the present clinical setting.     

美托洛尔对缺血性心力衰竭大鼠心肌细胞凋亡的影响

目的：探讨美托洛尔对心力衰竭（心衰）大鼠心肌细胞凋亡的影响。方法：构建心衰大鼠模型,随机分为心衰组、美托洛尔组（各15只）及假手术组（n=15）,为同期开胸,无血管结扎,8周后,测定血流动力学指标,观察左右心室质量指数（LVMI．RVMI）,TUNEL法检测心肌细胞凋亡率。结果：①与假手术组比较,心衰组血流动力学指标明显恶化,LVMI和RVMI显著升高,心肌细胞凋亡率增加;②与心衰组比较,美托洛尔组,MBP和LVEDP下降,±dp／dtmax均升高,LVMI和RVMI下降,心肌细胞凋亡率下降。结论：美托洛尔能抑制心肌细胞凋亡,改善心功能,逆转心室重构。     

Similar Risk Reduction of Death of Extended-Release Metoprolol Once Daily and Immediate-Release Metoprolol Twice Daily During 5 Years After Myocardial Infarction

Summary. The pooled results from five placebo-controlled postinfarction studies with metoprolol have shown a significant reduction in total mortality. All five studies used immediate-release metoprolol twice daily. An extended-release formulation of metoprolol for once-daily use has since been developed. The aim of the present study was to compare the two different forms of metoprolol with regard to the risk reduction of death for 5 years postinfarction and to analyze whether treatment with the beta-blocker metoprolol is associated with a reduced mortality after the introduction of modern therapies such as thrombolysis, aspirin, and ACE inhibitors. All patients discharged after an acute myocardial infarction (AMI) from Sahlgrenska University Hospital (SU) during 1986–1987 (n = 740, Period I) and during 1990–1991 (n = 1446, Period II) from both SU and Östra Hospital, Göteborg, Sweden, were included in the study during Period I, 56% were prescribed immediate-release metoprolol compared with 61% prescribed extended-release metoprolol during Period II. Immediate-release metoprolol was not available for outpatient use during Period II. In a multivariate analysis, all variables significantly associated with either increased or decreased postinfarction mortality during Periods I and II (univariate analysis of patient characteristics, medical history, complications during the AMI medication at discharge) studied were with Cox's proportional hazards model. Treatment with immediate-release metoprolol was significantly associated with reduced mortality over 5 years during Period I (relative risk reduction for total mortality, –34%, P = 0.003; 95% CI for RR, 0.51–0.87), and treatment with extended-release metoprolol was significantly associated with reduced mortality during Period II (–34%, P < 0.0001; 95% CI for RR, 0.53–0.82). Thrombolysis and the use of aspirin and ACE inhibitors were more frequently used during Period II. The results showed that postinfarction treatment with extended-release metoprolol given once daily was associated with a similar risk reduction of death over 5 years as immediate-release metoprolol given twice daily. The data, furthermore, indicate that the beta-blocker metoprolol is associated with a reduced risk of death after the introduction of modern therapy such as thrombolysis, aspirin, and ACE inhibitors.     

Heart failure: Effects of beta receptor antagonists on left ventricular function in patients with clinical evidence of heart failure after myocardial infarction. A double-blind comparison of metoprolol and xamoterol Echocardiographic results from the Metoprolol and Xamoterol Infarction Study (MEXIS)

Two hundred and ten patients with clinical evidence of heartfailure, developing after an acute myocardial infarction, wererandomized to treatment with the ß₁ antagonist metoprolol50–100mg b.i.d. (n=106) or the ß₁ partial agonistxamoterol 100–200 mg bid. (n=104). Left ventricular systolicand diastolic function were assessed with echocardiography andtransmitral Doppler cardiography before and after 3 and 12 monthsof double-blind treatment. E-point septal separation and percent left ventricular fractional shortening were used as indicesof systolic function. The ratio between peak early and latemitral diastolic flow (E/A ratio) and isovolumic relaxationtime were used as indices of diastolic function. In the xamoterol group, there was a deterioration in E-pointseptal separation (P<0·05). A difference between thetreatment groups was present both at 3 months (E-point septalseparation 11·4 vs 13·0 mm, P<0·0l,fractional short ening 271 vs 252%, P<005) and 12 months(E-point septal separation Ill vs 13·2 mm, P<0·05fractional shortening 26·9 vs 25·0%, P<0·05).E/A ratio increased in the metoprolol group (P<0·05)but not in the xamoterol group. At 3 months there was a significantdifference (0·85 vs 0·67, P<0·005 betweenthe groups but not at 12 months. In comparison with the ß₁-receptor antagonist metoprolol,the ß₁ partial agonist xamoterol impaired left ventricularsystolic function in patients with clinical evidence of heartfailure after an acute myocardial infarction.     

美托洛尔对心肌梗死兔自主神经重构的影响

目的探讨β受体阻滞剂美托洛尔治疗对心肌梗死后心脏自主神经重构的改善作用。方法通过结扎新西兰大白兔冠状动脉前降支制作心肌梗死模型,随机分成心肌梗死 美托洛尔组[(10mg/(kg·d),治疗组)、心肌梗死组(模型组)和假手术组。8周后所有成活兔均进行统一的电生理检查,诱发室性心律失常。并处死实验动物,取心肌采用免疫组织化学的方法观察心室神经纤维的形态、密度及生长活性。结果模型组室性心律失常诱发率明显高于假手术组(58.3%比16.7%,P<0.001),而美托洛尔治疗后其诱发率降至8.3%。模型组梗死灶周S100及GAP43阳性神经纤维密度分别达到3889±521μm2/mm2和3090±622μm2/mm2,明显高于假手术组(1727±304μm2/mm2和718±177μm2/mm2;P均<0.01),且神经纤维空间分布紊乱;而治疗组梗死灶周S100及GAP43阳性神经纤维密度降至2725±283μm2/mm2和1922±508μm2/mm2,与模型组比差异均有统计学意义(P<0.05),且神经形态及分布更类似于假手术组,非梗死左心室游离壁心肌梗死后密度上调的S100及GAP43阳性神经纤维经美托洛尔治疗后也明显下降(P<0.05)。结论美托洛尔可改善心肌梗死动物模型的神经重构,从而可能预防心肌梗死后室性心律失常的发生。     

扎莫特罗治疗重症心衰

标题　Ｘａｍｏｔｅｒｏｌ治疗重症心力衰竭作者　Ｘａｍｏｔｅｒｏｌ治疗重症心衰研究组,Ｌａｎｃｅｔ,１９９０,３３６：１～６（英文）　　研究疾病：充血性心力衰竭。目的：估价Ｘａｍｏｔｅｒｏｌ治疗心衰的疗效和安全性。　　设计：随机、双盲、安慰剂对照的多中心研究。病人资料：５１６例１８岁以上的患有ＮＹＨＡⅢ和Ⅳ级心力衰竭者,用利尿剂和血管紧张素转换酶抑制剂治疗无效;８周内曾有心肌梗死者和闭经前的妇女均被排除。随访：治疗前和平均用安慰剂８６ｄ及Ｘａｍｏｔｅｒｏｌ８７ｄ后,做临床检查和运动试验。治疗方案：…     

不同剂量美托洛尔治疗急性心肌梗死病人6个月的随访观察

目的 :用超声心动图观察美托洛尔对急性心肌梗死 (AMI)病人左室收缩功能的作用 ,比较不同剂量美托洛尔的作用。方法 :将 12 3例病人随机分为 4组 ,对照组及 3个不同剂量( 2 5mg组 ,5 0mg组 ,10 0mg组 )的美托洛尔组 ,4组的基础治疗相似。于用药前、用药后 3个月、6个月 ,分别记录心功能状态、心率、血压、生活质量等 ,同时用超声心动图检测心功能状况。结果 :经过 6个月的治疗 ,美托洛尔组收缩功能改善 ,与对照组比较 ,5 0mg组和 10 0mg组均可使左室射血分数 (LVEF)上升 (P <0 .0 5 ) ;10 0mg组使左室收缩末容积 (LVESV )下降 (P <0 .0 1) ,左室舒张末容积(LVEDV)亦减少 (P <0 .0 5 ) ,但 2 5mg组作用无统计学意义。在 3个月时 ,治疗组和对照组比较无统计学意义。结论 :AMI病人出院后较长期坚持服用美托洛尔 ,可使收缩功能改善 ,减少左室重塑 ,改善临床症状。 3个剂量组中 ,10 0mg剂量组的作用显著。提示目前临床上 ,欲取得 β1-受体对心脏的有益作用 ,应服用足量美托洛尔。     

Tolerability to Treatment with Metoprolol in Acute Myocardial Infarction in Relation to Age

ABSTRACT A double-blind trial with the β₁-selective blocker metoprolol in suspected acute myocardial infarction and during 3 months' follow-up included 1 395 patients, aged 40–74 years, 698 on metoprolol and 697 on placebo. In order to further evaluate the tolerability to β-blockade in the elderly, the total series was divided into 2 groups according to median age (61 years) and into quartiles, the lowest quartile (40–57 years) being compared with the highest (67–74 years). The decrease in heart rate and systolic blood pressure after intravenous metoprolol in the acute phase was similar in the elderly and the younger patients. Hypotension was observed more often in the metoprolol-treated than in the placebo-treated younger patients, while no difference was observed in the elderly. Bradycardia was observed more often in the motoprolol group in both age groups, while there was no difference regarding the incidence of congestive heart failure in either the younger or in the elderly patients. The effect on mortality, serious ventricular arrhythmias and chest pain seemed to be similar in different age groups. From the present series we conclude that hemodynamic reactions and tolerability to β-blockade can be expected to be similar in elderly and younger patients.     

中国第二项急性心肌梗死研究（摘要）

疾病 急性心肌梗死;目的 探讨联合抗血小板药(阿司匹林和氯吡格雷)及β受体阻断药美托洛尔(倍他乐克)治疗急性心肌梗死(acute myocardial infarction，AMI)的疗效     

中国第二项急性心肌梗死研究

疾 病 急性心肌梗死 目 的 探 讨 联 合 抗 血 小 板 药 (阿司匹林和氯吡格雷)及 茁受体阻断 药美托洛尔(倍他乐克)治疗急性心肌 梗死 (acute m yocardial infarction,AM I) 的疗效 研究设计 多中心、双盲、安慰剂 对照的大规模、随机临床试验 随 访 52个月(1999年 11月～ 2005年 2月.) 病 人 近 46000例 发病 24小时之内的急性心肌梗死病人 治疗方案 发病 24小时之内的急 性心肌梗死病人,如果不存在明显心力 衰竭、支气管哮喘、持续性低血压(收缩 压<100m m H g)、心动过缓 (心率<60 次 /分)和房室传导阻滞(PR 间期>0.24 秒)等,应尽快以…