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首页> 外文期刊>International Journal of Cardiology >Facilitated PCI by combination fibrinolysis or upstream tirofiban in acute ST-segment elevation myocardial infarction: results of the Alteplase and Tirofiban in Acute Myocardial Infarction (ATAMI) trial.
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Facilitated PCI by combination fibrinolysis or upstream tirofiban in acute ST-segment elevation myocardial infarction: results of the Alteplase and Tirofiban in Acute Myocardial Infarction (ATAMI) trial.

机译：在急性ST段抬高型心肌梗死中联合纤溶或上游替罗非班促进PCI：阿替普酶和替罗非班在急性心肌梗死（ATAMI）试验中的结果。

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Direct percutaneous coronary intervention is the generally accepted superior strategy in acute ST-segment myocardial infarction. The concept of facilitating PCI in order to overcome delay by door-to-balloon time or transport is nevertheless of interest. Combination fibrinolysis guarantees higher rates of open infarct-related vessels and reduced reocclusion but without reduction of mortality. After a pilot trial of facilitated PCI by combination fibrinolysis in 39 patients with excellent efficacy and high safety we prospectively randomised 151 patients (96 males, mean age 67.4+/-8.7 years) to combination fibrinolysis with 50 mg alteplase and tirofiban and 162 patients (103 males, mean age 65.6+/-9.4 years) to upstream tirofiban before invasive approach including PCI. TIMI 2 or 3 flow of infarct-related vessel before intervention as the primary endpoint and 30-day mortality, bleeding complication and angiographic proven stent thrombosis as secondary endpoints were assessed. 160 matched patients with acute PCI and provisional abciximab served as a control group. RESULTS: TIMI 2 or 3 flow in the infarct-related vessel could be demonstrated in 87% in the combination fibrinolysis group, in 42% in the upstream tirofiban group (p<0.0001) and 29% in the control group. 30-day mortality was 0.7% versus 5.5% (p<0.02) and 6.3% in the control group. No differences could be assessed in severe or moderate (1.3% vs 1.2% vs 1.2%) and mild bleeding complications (2% vs 1.9% vs 2.5%). Stent thrombosis occurred in none of the patients with combination fibrinolysis, in 2 patients (1.5%) in the upstream tirofiban group and in 7 cases (4.4%) in the control group. CONCLUSIONS: Combination fibrinolysis before PCI leads to significantly higher TIMI flow rates of the infarct-related vessel without increase in 30-day mortality or in bleeding complications. This strategy needs to be further investigated in larger trials and could optimise acute myocardial infarction management even without 24-h service of catheter laboratories.
机译：在急性ST段心肌梗死中，直接经皮冠状动脉介入治疗是公认的优越策略。尽管如此，促进PCI克服门对气球时间或运输延误的概念仍然令人关注。联合纤维蛋白溶解保证更高的开放性梗死相关血管的发生率并减少再阻塞，但不会降低死亡率。在39例具有出色疗效和高安全性的联合纤溶治疗中对PCI进行促进试验后，我们预期将151例患者（96名男性，平均年龄67.4 +/- 8.7岁）随机分为50毫克阿替普酶和替罗非班联合纤溶治疗和162例患者（ 103名男性，平均年龄65.6 +/- 9.4岁）接受包括PCI在内的侵入性治疗之前接受替罗非班治疗。评估干预前的梗死相关血管的TIMI 2或3流量为主要终点，评估30天死亡率，出血并发症和血管造影证实的支架血栓为次要终点。 160例匹配的急性PCI患者和临时阿昔单抗作为对照组。结果：在纤维蛋白溶解联合治疗组中，梗死相关血管中的TIMI 2或3流动可证明为87％，上游替罗非班组为42％（p <0.0001），而对照组为29％。 30天死亡率为0.7％，而对照组为5.5％（p <0.02）和6.3％。在重度或中度（1.3％vs 1.2％vs 1.2％）和轻度出血并发症（2％vs 1.9％vs 2.5％）方面没有差异。联合纤溶治疗的患者均未发生支架血栓形成，在替罗非班组中有2例（1.5％），在对照组中有7例（4.4％）。结论：PCI前联合纤维蛋白溶解可显着提高梗死相关血管的TIMI流速，而不会增加30天死亡率或出血并发症。这种策略需要在更大的试验中进一步研究，即使没有导管实验室的24小时服务，也可以优化急性心肌梗死的治疗。

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