| Autor: |
Run-lin, Gao, Ya-ling, Han, Xin-chun, Yang, Jie-ming, Mao, Wei-yi, Fang, Lei, Wang, Wei-feng, Shen, Zhan-quan, Li, Guo-liang, Jia, Shu-zheng, Lü, Meng, Wei, Ding-yin, Zeng, Ji-lin, Chen, Xue-wen, Qin, Bo, Xu, Chang-hui, DU, Jin-fa, Shi |
| Rok vydání: |
2010 |
| Předmět: |
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| Zdroj: |
Chinese medical journal. 123(11) |
| ISSN: |
2542-5641 |
| Popis: |
Although thrombolytic therapy with rescue percutaneous coronary intervention (PCI) is a common treatment strategy for ST-segment elevation acute myocardial infarction (STEMI), scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study.This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients (ageor = 70 years) with STEMI who presented within 12 hours of symptom onset (mean interval3 hours). Patients were randomized to three groups: primary PCI group (n = 101); recombinant staphylokinase (r-Sak) group (n = 104); and recombinant tissue-type plasminogen activator (rt-PA) group (n = 106). For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery (IRA) patency; rescue PCI was performed in cases with TIMI flow gradeor = 2. Bare-metal stent implantation was planned for all patients.After randomization it required an average of 113.4 minutes to start thrombolytic therapy (door-to-needle time) and 141.2 minutes to perform first balloon inflation in the IRA (door to balloon time). Rates of IRA patency (TIMI flow grade 2 or 3) and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure (70.5% vs. 98.0%, P0.0001, and 53.0% vs. 85.9%, P0.0001, respectively). Rescue PCI with stenting was performed in 117 patients (55.7%) in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group (88.9% vs. 97.9%, P = 0.0222, and 68.4% vs. 85.0%, P = 0.0190, respectively). At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group (7.1% vs. 0, P = 0.0034). Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group (10.0% vs. 1.0%, P = 0.0380, and 28.10% vs. 8.91%, P = 0.0001, respectively).Thrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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