陈明,蒋若瑜,解冰,洪涛,霍勇

• 1:北京大学第一医院心内科
• 2:北京大学第一医院心内科
• 3:北京大学第一医院心内科
• 4:北京大学第一医院心内科

摘要(Abstract)：

目的回顾性分析溶栓联合经皮冠状动脉介入治疗(PCI)的效果和安全性。方法北京大学第一医院溶栓联合PCI的心肌梗死患者45例,与同期单纯溶栓(31例)和直接PCI(74例)的心肌梗死病例对比分析。结果冠状动脉造影资料显示溶栓联合PCI组的TIMI3级血流占88.9%,较单纯溶栓组(74.2%)高(P=0.087),与直接PCI组(91.9%)相似(P=0.404)。临床资料显示溶栓联合PCI组的主要心血管事件(MACE)占4.4%,较单纯溶栓组(12.9%)低(P=0.181),与直接PCI组(1.4%)相似(P=0.319)。三组病例的住院死亡率相似(4.4%,6.5%,4.1%)。住院期间的主要出血事件(包括大出血和颅内出血)相似(4.4%,3.2%,1.4%)。结论溶栓联合PCI的再灌注效果可能优于单纯溶栓,至少不逊于直接PCI,且安全性良好。

关键词(KeyWords)： 心肌梗死;溶栓;血管成形术,经腔,经皮冠状动脉

Abstract:

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基金项目(Foundation):

作者(Author): 陈明,蒋若瑜,解冰,洪涛,霍勇

参考文献(References)：

• 1Ross AM,Coyne KS,Reiner JS,et al.Arandomized trial comparing primary angioplasty with a strategy of short-acting thrombolysis and immediate planned rescue angioplasty in acute myocardial infarction:the PACTtrial.J AmColl Cardiol,1999,34:1954-1962.
• 2Antman EM,Giugliano RP,Gibson CM,et al.Abciximab facilitates the rate and extent of thrombolysis:results of the Thrombolysis in Myocardial Infarction(TIMI)14trial.Circulation,1999,99:2729-2732.
• 3De Lemos JA,Antman EM,Gibson CM,et al.Abciximab improves both epicardial flow and myocardial reperfusion in ST-elevationmyocardial infarction:observations from the TIMI14study.Circulation,2000,101:239-243.
• 4Strategies for Patency Enhancement in the Emergency Department(SPEED)Investigators.Trial of abciximab with and without low-dose reteplase for acute myocardial infarction.Circulation,2000,101:2788-2794.
• 5Topol EJ,for the the GUSTO VInvestigators.Reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and platelet glycoproteinⅡb/Ⅲa inhibition:the GUSTO Vrandomised trial.Lancet,2001,357:1905-1914.
• 6Lincoff AM,Califf RM,van de Werf F,et al.for the GUSTO V Investigators.Mortality at1year with combination platelet glycoprotein IIb/IIIa inhibition and reduced-dose fibrinolytic therapy versus conventional fibrinolytic therapy for acute myocardial infarction:The GUSTO Vrandomizedtrial.JAMA,2002,288:2130-2135.
• 7Montalescot G,Barragan P,Wittenberg O,et al,for the ADMIRAL investigators.Platelet glycoproteinⅡb/Ⅲa inhibition with coronary stentingfor acute myocardial infarction.N Engl J Med,2002,344:1895-1903.
• 8Brener SJ,Zeymer U,Adgey AAJ,et al.Eptifibatide and low-dose tissue plasminogen activator in acute myocardial infarction:the Integrilin and Low-Dose Thrombolysis in Acute Myocardial Infarction(INTRO AMI)Trial.J AmColl Cardiol,2002,39:377-386.
• 9Widimsky P,Budesinsky T,Vorac D,et al.Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction:final results of the randomized national multicentre trial:PRAGUE-2.Eur Heart J,2003,24:94-104.