瑞替普酶治疗急性ST段抬高性心肌梗死疗效观察

目的：观察瑞替普酶（r PA）治疗急性 ST段抬高性心肌梗死的临床疗效及出血不良反应发生情况。方法选取2011年6月—2013年6月我院住院的90例急性 ST段抬高性心肌梗死病人,随机分为瑞替普酶组（47例）和尿激酶组（43例）。观察两组的临床溶栓再通率及出血不良反应。结果瑞替普酶组30 min、60 min、90 min、120 min临床冠状动脉再通率分别为12.76%、61.70%、74.47%、80.85%。尿激酶组临床冠状动脉再通率分别为2.32%、23.25%、51.16%、55.81%。瑞替普酶组各时间段冠脉再通率均高于尿激酶组,差异有统计学意义（P〈0.05）。瑞替普酶组早期溶栓与晚期溶栓冠状动脉再通率高于对照组（P〈0.05）。两组出血不良反应比较差异无统计学意义。结论瑞替普酶治疗急性 ST段抬高性心肌梗死疗效显著,是一种高效安全的溶栓药。     

瑞替普酶溶栓治疗老年ST段抬高型心肌梗死的疗效观察

目的观察瑞替普酶治疗老年(60岁)ST段抬高型急性心肌梗死患者的溶栓效果及安全性。方法选取2013年1月至2016年12月在我院治疗的急性ST段抬高型心肌梗死患者73例为研究对象,采用随机数字表法随机分为瑞替普酶组(38例)和尿激酶组(35例),分别采用瑞替普酶和尿激酶进行静脉溶栓治疗。比较两组患者梗死相关血管的血管再通率、出血并发症发生率以及住院病死率。结果瑞替普酶组患者溶栓治疗后30 min、60 min、90 min、120 min的血管再通比例,即临床再灌注成功率均显著高于尿激酶组,差异有统计学意义(P0.05)。在溶栓后1~2周行冠脉造影检查,瑞替普酶组患者冠脉血管再通率,即冠脉造影再灌注成功率,无论是TIMI 2级还是TIMI 3级均显著高于尿激酶组,差异有统计学意义(P0.05)。瑞替普酶组患者出血并发症发生率(10.5%)显著低于尿激酶组(34.3%),差异有统计学意义(P0.05)。结论瑞替普酶治疗老年急性ST段抬高型心肌梗死患者的溶栓效果优于尿激酶,安全性高于尿激酶。     

瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中的疗效比较

目的 研究瑞替普酶(r-PA)和阿替普酶(rt-PA)在急性ST段抬高型心肌梗死患者溶栓治疗中的疗效及安全性.方法 选择2011年8月-2012年8月心内科收治的80例无溶栓禁忌证急性ST段抬高型心肌梗死患者,按照随机分组原则,平均分为两组.瑞替普酶治疗组40例,给予静脉推注瑞替普酶.阿替普酶治疗组40例,给予先静脉推注后静脉泵入阿替普酶.溶栓治疗后观察患者溶栓再通时间、再通率、不良反应发生率、病死率等.评价两种药物的临床疗效和安全性.结果 瑞替普酶组与阿替普酶组临床资料情况相比较无统计学意义(P>0.05);r-PA组与rt-PA组血管再通率分别为85%和80%(P>0.05);在心肌损伤程度、改善心功能方面两药无统计学意义;安全性上两种药都有轻度出血,差异无统计学意义.结论 瑞替普酶与阿替普酶治疗急性ST段抬高型心肌梗死的疗效及安全性相同,但瑞替普酶更经济、操作更简便、更适合临床使用.     

重组人尿激酶原与瑞替普酶治疗急性ST段抬高型心肌梗死的疗效分析

目的比较重组人尿激酶原与瑞替普酶治疗急性ST段抬高型心肌梗死的疗效。方法回顾性分析湖南省汨罗市人民医院2016年10月至2017年9月急性ST段抬高型心肌梗死溶栓治疗37例病例临床资料,其中重组人尿激酶原溶栓治疗16例(重组人尿激酶原组),瑞替普酶溶栓治疗21例(瑞替普酶组),分别给与尿激酶原50mg,瑞替普酶36mg,观察罪犯血管的开通率、出血并发症及不良心脏事件发生率。结果重组人尿激酶原组再通14例,再通率为87.5%,瑞替普酶组再通17例,再通率为80.9%,重组人尿激酶原组与瑞替普酶组具有相似的罪犯血管开通率,差异无统计学意义。重组人尿激酶原组出血等不良反应12.5%,瑞替普酶组出血等不良反应28.6%,重组人尿激酶原组较瑞替普酶组低(χ2=6.16,P=0.032)。结论重组人尿激酶原与瑞替普酶均具有高效的罪犯血管开通率,重组人尿激酶原出血并发症及主要不良反应发生率更低,安全性更高。     

瑞替普酶在急性ST段抬高型心肌梗死溶栓治疗中的有效性及安全性研究

目的观察瑞替普酶与尿激酶用于急性ST段抬高型心肌梗死病人溶栓治疗的有效性及安全性。方法将113例急性ST段抬高型心肌梗死病人随机分为瑞替普酶组(57例)与尿激酶组(56例),观察两组溶栓冠脉血管再通率、心血管事件的发生情况、出血并发症及住院期间死亡情况,比较两种药物溶栓治疗的有效性及安全性。结果瑞替普酶组治疗后30min,1h及2h血管再通率均高于尿激酶组,差异有统计学意义(P0.01);发病距溶栓时间在6h以内和(6~12)h再通率相比较,瑞替普酶组均高于尿激酶组,差异有统计学意义(P0.05);两组溶栓后住院期间心血管事件及并发症的发生情况,无统计学意义(P0.05)。结论瑞替普酶较尿激酶有更高的血管再通率,能够早期快速开通血管,是一种安全有效的溶栓药物。     

瑞替普酶与尿激酶在急性ST段抬高心肌梗死溶栓治疗中的疗效比较

目的 研究瑞替普酶和尿激酶在急性ST段抬高心肌梗死患者溶栓治疗中的疗效及安全性.方法 选用符合溶栓标准的急性心肌梗死患者65例.随机分为观察组(瑞替普酶)33例与对照组(尿激酶)32例.观察两组血管再通率、肌钙蛋白达峰时间、出血率、病死率.结果 观察组再通率82.1%明显,优于对照组的62.5%(P＜0.05)、出血发生率6.1%、肌钙蛋白达峰时间13.4 h±2.3 h,明显低于对照组,两组比较差异有统计学意义(P＜0.05);两组病死率无统计学意义.结论 瑞替普酶在急性心肌梗死溶栓治疗中再通率安全性优于尿激酶.     

瑞替普酶与尿激酶静脉溶栓治疗急性ST段抬高型心肌梗死的效果和安全性

目的探究瑞替普酶与尿激酶静脉溶栓治疗急性ST段抬高型心肌梗死的效果和安全性。方法选取2015年3月~2016年3月期间,我院接受治疗的48例急性ST段抬高型心肌梗死患者作为研究对象,按照治疗药物的不同分为治疗组(n=24)和对照组(n=24),对照组采用尿激酶进行治疗,治疗组采用瑞替普酶联合尿激酶还原型谷胱甘肽进行治疗,观察分析两组患者的治疗效果,CK(肌酸激酶)、cTnT(肌钙蛋白)和SOD(超氧化物歧化酶)的水平,出血发生率和临床再通率。结果治疗组的临床效果优于对照组,CK、cTnT和SOD的水平改善情况好于对照组,出血发生率和临床再通率与对照组相比存在较大差异,两组患者差异显著(P0.05),有统计学意义。结论采用瑞替普酶与尿激酶静脉溶栓治疗急性ST段抬高型心肌梗死患者具有较大的意义。     

瑞替普酶与尿激酶对急性心肌梗死患者院内治疗有效性及安全性的多中心随机对照研究

目的对比观察瑞替普酶与尿激酶用于急性ST段抬高型心肌梗死患者溶栓治疗的疗效及安全性。方法2014年河南省34家医院参加本研究,356例急性ST段抬高型心肌梗死患者符合入排标准入选,随机分组给予瑞替普酶(n=178)或尿激酶(n=178)溶栓治疗。溶栓后通过监测临床症状、心电图、心肌酶及心律变化判断溶栓再通率,并观察住院期间心血管事件及出血事件的发生率,出血事件采用全球梗死相关动脉开通策略(GUSTO)分级。结果瑞替普酶组溶栓后2 h临床标准判断血管再通率为88.6%(156/176),尿激酶组为51.1%(91/178)(P0.001),瑞替普酶组血管再通时间较尿激酶组平均提早18 min(IC95%11~25)(P0.001)。瑞替普酶组溶栓后住院期间死亡率为0.6%(1/176),尿激酶组为3.4%(6/178)(P0.05)。瑞替普酶组与尿激酶组均无GUSTO严重出血事件发生,GUSTO中度出血率分别为1.7%(3/176)、0.0%(0/178)(P0.05);GUSTO轻度出血率分别为6.8%(12/176)、2.8%(5/178)(P0.05)。结论与尿激酶相比,瑞替普酶具有更高的血管再通率,不良反应少,是一种安全有效的溶栓药物。     

基层医院应用瑞替普酶治疗急性心肌梗死的疗效观察

目的 观察基层医院应用瑞替普酶治疗急性ST段抬高心肌梗死的疗效和安全性.方法 对入选的87例急性心肌梗死患者进行瑞替普酶静脉溶栓治疗,利用患者ST段回落、肌酸激酶同工酶、再灌注心律失常及胸痛症状间接判断梗死血管是否再通,观察疗效.结果 瑞替普酶治疗急性心肌梗死30 min、60 min和90 min的血管再通率分别是37.9%、67.8%和92.0%,随访35 d死亡率为6.9%.所有患者均未出现严重不良反应.结论 在基层医院应用瑞替普酶溶栓治疗急性ST段抬高心肌梗死有较好疗效和安全性.     

瑞替普酶溶栓后转运PCI治疗急性ST段抬高型心肌梗死的临床观察

目的探讨瑞替普酶静脉溶栓后早期经皮冠状动脉介入(PCI)治疗急性ST段抬高型心肌梗死的疗效及出血风险。方法选择54例急性心肌梗死患者作为研究对象,瑞替普酶组为我院2016年1月至2016年12月收治的由其他海岛医院经瑞替普酶溶栓后转运的急性心肌梗死行急诊PCI的28例患者,与2015年1月至2015年12月未溶栓转运行急诊PCI的26例患者进行比较,观察两组的梗死相关血管再通率和术后出血发生率,术后1月通过心脏彩超检测各组患者左心室射血分数值(LVEF)和左心室舒张末期内径(LVEDD)。结果瑞替普酶组梗死相关血管再通率(82.14%)显著高于对照组(11.54%,),瑞替普酶组的LVEF值高于对照组,而LVEDD值小于对照组,差异均有统计学意义(P0.05);瑞替普酶组(21.43%)的术后出血发生率与对照组(19.23%)无统计学意义(P0.05)。结论瑞替普酶溶栓治疗后早期PCI能有效开通血管,减少转运途中时间延误造成心肌损伤及心梗后并发症,且出血风险小,适用于交通不便地区及首次医疗接触(FMC)至PCI治疗时间大于120分钟的医院。     

rPA联合还原型谷胱甘肽治疗急性ST段抬高型心肌梗死的疗效

目的：观察重组人组织型纤溶酶原激活剂（rPA）联合还原型谷胱甘肽（GSH）治疗急性ST段抬高型心肌梗死（STEMI）的疗效及安全性。方法：80例急性STEMI患者被随机均分为常规溶栓组和GSH组（溶栓＋GSH治疗）。分别于治疗前、治疗后24h检测两组患者血浆cTnT、CK-MB以及超氧化物歧化酶（SOD）活力;1个月后随访不良心血管事件（MACE）发生率,测定LVEDd、LVESd和LVEF。结果：（1）治疗后两组CK-MB,cT-nT、SOD水平均显著升高（P均〈0.01）,但与常规溶栓组比较,GSH组血浆CK-MB,cTnT水平较低,SOD水平更高（P均〈0.05）;（2）与常规溶栓组比较,GSH组LVEDd[（55.01±3.56）mm比（51.58±2.97）mm]、LVESd[（47.34±4.83）mm比（42.95±4.58）mm]明显减小,LVEF明显增大[（54.76±4.73）%比（61.21±6.38）%],P均〈0.05;3、GSH组较常规溶栓组梗死后心绞痛发生率（22.5%比35.0%）、再发心肌梗死率（5.0%比22.5%）、严重心律失常（17.5%比37.5%）发生率显著下降（P均〈0.05）。结论：rPA溶栓联合GSH治疗急性STEMI,能减少冠状动脉再通后并发症,改善心室重构,GSH对缺血再灌注损伤心肌有良好的保护作用。     

重组链激酶治疗急性心肌梗死的疗效和安全性

目的　探讨老年急性心肌梗死患者接受重组链激酶溶栓治疗的疗效和安全性。方法　 2 5 5例急性心肌梗死患者分为老年组 (15 7例 )和非老年组 (98例 ) ,分别对两组的临床疗效进行比较。结果　非老年组与老年组比较 ,其梗死相关血管再通率 (81.6 %vs79.0 % )、梗死后心绞痛 (8.2 %vs7.6 % )、再梗死 (2 .0 %vs3.2 % )、严重心律失常(11.2 %vs10 .8% )、心源性休克 (5 .1%vs5 .1% )、出血 (2 3.5 %vs2 1.7% )及其他并发症的发生率均无显著性差异(P >0 .0 5 )。结论　老年急性心肌梗死接受重组链激酶溶栓治疗是安全、有效的。     

重组链激酶、尿激酶溶栓治疗急性心肌梗死的对比研究

目的观察国产重组链激酶(r-SK)在急性心肌梗死(AMI)静脉溶栓治疗中的临床疗效和不良反应,用尿激酶(UK)作为对照,评价r-SK的安全性.方法采用平行随机单盲对照试验,将128例符合入选标准的AMI病人随机分为两组,r-SK组65例,UK组63例,予r-SK 1.5×106 U于60 min内静脉输注,UK 1.5×106 U于30 min内静脉输注,观察血管再通的临床指标、药物不良反应及出血并发症等.结果在随机单盲对照试验中,r-SK组的血管再通率为81.5%,UK组的血管再通率为58.7%,两组相比有统计学意义(P＜0.05),r-SK 组的不良反应中,变态反应(寒战、发热及皮疹等)的发生率为9.5%,UK组为11.3%(P＞0.05),低血压的发生率两组相比无统计学意义,两组均无过敏性休克和颅内出血发生.结论国产r-SK是一种血管再通率较高,不良反应及出血并发症发生率低,安全有效的溶栓药物.     

Angiographic outcomes in STEMI patients receiving fibrinolysis with guideline directed optimal antithrombotic therapy

STEMI is a major public health problem requiring timely reperfusion. Fibrinolysis remains prevalent reperfusion strategy where timely primary percutaneous coronary intervention (PCI) cannot be performed. Adjunctive antithrombotic agents are of utmost importance for maximizing the benefit of fibrinolysis. This prospective study evaluates the angiographic outcomes in STEMI patients receiving fibrinolysis with optimal antithrombotic therapy and reported TIMI 3 flow rates of 33.8% and 41.5% for streptokinase and reteplase respectively, that were significantly higher than various prior studies. This data reiterates the utility of thrombolysis in resource limited settings.     

国产瑞替普酶联合磺达肝癸钠治疗急性ST段抬高性心肌梗死32例临床分析

目的:总结国产瑞替普酶联合磺达肝癸钠治疗急性ST段抬高性心肌梗死(STEMI)的临床疗效和安全性。方法:收集2011-03-2011-10我院年龄≤75岁的STEMI患者32例,给予国产瑞替普酶联合磺达肝癸钠治疗,观察临床效果。结果:90min临床判断血管再通24例(75.0%),5例(15.6%)患者接受介入治疗,全部患者住院期间无严重出血、过敏及死亡事件发生。结论:国产瑞替普酶联合磺达肝癸钠是STEMI患者再灌注治疗用药的理想组合。     

Prehospital thrombolysis with reteplase: the Nijmegen/Rotterdam study

Objective

The objective of this observational study was to assess time from electrocardiogram diagnosis to treatment and time from pain onset to treatment with double bolus reteplase compared to current therapy with streptokinase or bolus anistreplase in 2 cities (Rotterdam and Nijmegen) in the Netherlands, where prehospital thrombolysis is an established way of treatment of acute myocardial infarction.

Methods

Prehospital thrombolysis is performed using electrocardiogram diagnosis by the ambulance service as well as bolus anistreplase for treatment in Nijmegen, and streptokinase infusion in Rotterdam. Reteplase or anistreplase/streptokinase was assigned open label to patients according to order of presentation on a 1-to-1 basis. All patients were treated with nitrates sublingually and aspirin orally. Time intervals were recorded by the ambulance staff.

Results

In total, 250 patients were treated between April 1, 1999 and August 1, 2000. Reteplase was used in 120 patients and anistreplase/streptokinase in 130 patients. Using double bolus reteplase resulted in a significantly shorter time to treatment: a median of 81 minutes compared to a median of 104 minutes with the established therapy (P < .0001). There were no differences in mortality, aborted myocardial infarction, hemorrhagic stroke or the need for rescue angioplasty between the groups.

Conclusion

In prehospital thrombolysis, double bolus reteplase is associated with a shorter time to treatment than bolus anistreplase or infusion of streptokinase.     

Clinical and biochemical predictors affect the choice and the short-term outcomes of different thrombolytic agents in acute myocardial infarction

BACKGROUND: The presence of plasminogen activator inhibitor-1, angiotensin-converting enzyme and others may play a role in unsuccessful recanalization after thrombolytic therapy. OBJECTIVES: To find out the clinical and biochemical predictors that may affect the choice and short-term outcomes following different thrombolytic agents in acute myocardial infarction. METHODOLOGY: Angiotensin-converting enzyme and plasminogen activator inhibitor-1 plasma levels of 184 patients with acute myocardial infarction, treated with streptokinase, metalyze or reteplase, were determined. Failure of thrombolysis was assessed by noninvasive reperfusion criteria. Prolonged hospitalization, impaired left ventricular ejection fraction and reinfarction were considered as short-term outcomes. RESULTS: Patients who received streptokinase developed higher incidence of >50% resolution of ST-segment elevation (82.5 vs. 64.7%, P-value<0.05, in comparison with metalyze and 82.5 vs. 55.7%, P-value 0.001, in comparison with reteplase) than those who received other thrombolytic agents. High plasma angiotensin-converting enzyme was associated with prolonged hospitalization (55, 63 and 94%, P<0.02) following streptokinase, metalyze and reteplase, respectively. High plasma plasminogen activator inhibitor-1 is associated with impaired left ventricular ejection fraction (55.3, 76.7 and 68.5%, P<0.09), ST resolution<50% (13.2, 36.7 and 37.5%, P=0.03), ST resolution>50% (86.8, 63.3 and 62.5%, P=0.03) following streptokinase, metalyze and reteplase, respectively. CONCLUSIONS: Rapid determination of pretreatment angiotensin-converting enzyme and plasminogen activator inhibitor-1 plasma levels in patients with acute myocardial infarction may influence the choice and outcomes of the thrombolytic agents. The presence of a high plasma level of either angiotensin-converting enzyme or plasminogen activator inhibitor-1 is significantly associated with adverse short-term outcomes after treatment with reteplase or metalyze.     

Lower long-term mortality within a regional system of care for ST-elevation myocardial infarction

Abstract

Introduction: Organization of regional systems of care (RSC) with an emphasis on pre-hospital triage and primary percutaneous coronary intervention (PCI) has been recommended to implement guidelines and improve clinical outcome in ST-segment elevation myocardial infarction (STEMI). Patients and methods: All STEMI patients (n = 1,823) admitted to any of the 13 hospitals of the province of Bologna, Italy, before (pre-RSC, n = 858) and after (RSC, n = 965) the implementation of a RSC were enrolled in the study. Primary evaluation was mortality. Secondary outcomes included death, myocardial infarction, stroke, and coronary revascularization procedures up to three-year follow-up. Results: Among patients admitted <12 h from symptom onset, reperfusion was performed in 68.7% pre-RSC versus 89.8% RSC, P <0.001. Within the RSC, primary PCI became the main reperfusion treatment (34.5% pre-RSC versus 85.9% RSC; P <0.001 for both), and one-year mortality was lower (23.9% pre-RSC versus 18.8% RSC; P = 0.0015). At three-year, this advantage was maintained and actually increased (31.7% pre-RSC versus 24.8% RSC; P = 0.0031). Independent predictors of mortality at three-years were RSC, age, heart failure, cerebrovascular disease, renal disease, shock, peripheral vascular disease, and malignancies. Conclusions: In this study, RSC for the treatment of STEMI was associated with increased rates of reperfusion and reduction of long-term mortality.     

Impact of type of thrombolytic agent on in-hospital outcomes in ST-segment elevation myocardial infarction patients in the Middle East

Little is known about the impact of thrombolytic agents on in-hospital outcomes in the Middle East. The objective of this study was to evaluate the impact of thrombolytic agents on in-hospital outcomes in ST-segment elevation myocardial infarction (STEMI) patients in six Middle Eastern countries. Gulf Registry of Acute Coronary Events was a prospective, multinational, multicentre, observational survey of consecutive acute coronary syndrome patients admitted to 65 hospitals in 2006 and 2007. Out of 1,765 STEMI patients admitted to hospitals within 12 h of symptoms onset, 25, 43, and 30% were treated with streptokinase, reteplase, and tenecteplase, respectively. Median age of the study cohort was 50 (45–59) years and majority were males (89%). The overall median symptom onset-to-presentation and median door-to-needle times were 130 min (65–240) and 45 min (30–75), respectively. Streptokinase patients had worse GRACE risk scores compared to patients who received fibrin specific thrombolytics. Academic hospitals and cardiologists as admitting physicians were associated with the use of fibrin specific thrombolytics. After significant covariate adjustment, both reteplase [odds ratio (OR), 0.38; 95% CI: 0.18–0.79; P = 0.009] and tenecteplase (OR, 0.30; 95% CI: 0.12–0.77; P = 0.012) were associated with lower all-cause in-hospital mortality compared with streptokinase. No significant differences in other in-hospital outcomes were noted between the thrombolytic agents. In conclusion, in light of the study’s limitations, fibrin specific agents, reteplase and tenecteplase, were associated with lower all-cause in-hospital mortality compared to the non-specific fibrin agent, streptokinase. However, the type of thrombolytic agent used did not influence other in-hospital outcomes.