Thrombolyse versus PTCA

Zusammenfassung

Die rasche Reperfusion von ischämischem Myokardgewebe durch erfolgreiche Thrombolyse hat die Letalität beim akuten Myokardinfarkt deutlich gesenkt. Bei etwa 20% der erfolgreich lysierten Patienten ist der klinische Verlauf allerdings durch Postinfarktangina und Reinfarkte gekennzeichnet, was auf die verbleibende Reststenose zurückgeführt wurde. Mehrere prospektive und randomisierte Studien zeigten, daß die prophylaktische koronare Angioplastie nach Thrombolyse keine Lösung dieses Problems darstellt. Die direkte PTCA ohne vorausgehende Fibrinolyse führt zwar in erfahrenen Händen zu höheren Rekanalisationsraten als die Thrombolysetherapie, aufgrund logistischer Probleme wird diese Revaskularisationsmethode allerdings auf wenige Patienten beschränkt bleiben. Außerdem fehlen augenblicklich überzeugende Daten, die schlüssig nachweisen, daß durch die primäre Angioplastie der klinische Verlauf günstiger beeinflußt wird als nach Thrombolyse.

Schlüsselwörter

Myokardinfarkt - Thrombolyse - Angioplastie

Keywords

Myocardial infarction - thrombolysis - angioplasty

• LITERATUR

• 1 De Wood MA, Spores J, Notske RN, Lang HT, Shield JP, Simpson CS, Rudy LW, Granwald R. Medical and surgical management of myocardial infarction. Am J Cardiol 1979; 44: 1356-64.
• 2 DeWood MA, Spores J, Notske RN, Mouser LT, Burroughs R, Golden MS, Lang HT. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 1980; 303: 897-902.
• 3 Giorgi LV, Rutherford BD, Hartzler GO, McConahay DR, Johnson WL. Direct PTC A for acute MI patients commonly excluded from thrombolytic trials (abstract). Circulation 1988; 78 (SupplII): I377.
• 4 Gruppo Italiano per lo Studio della Streptochinasi nellTnfarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; I: 397-401.
• 5 Hartzler GO, Rutherford BD, McConahay DR, Johnson Jr WL, McCallister BD, Gura Jr GM, Conn RC, Crockett JE. Percutaneous transluminal coronary angioplasty with and without thrombolytic therapy for treatment of acute myocardial infarction. Am Heart J 1983; 106: 965-73.
• 6 ISIS-2 Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17, 187 cases of suspected acute myocardial infarction: ISIS-3. Lancet 1988; II: 349-60.
• 7 Kahn JK, Rutherford BD, McConahay DR, Johnson Jr WL, Giorgi LV, Shimshak TM, Ligon RW, Hartzler GO. Catheterization laboratory events and hospital outcome with direct angioplasty for acute myocardial infarction. Circulation 1990; 82: 1910-5.
• 8 O’Neill W, Timmis GC, Bourdillon PD, Lai P, Ganghadarian V, Walton Jr J, Ramos R, Läufer N, Gordon S, Schork A, Pitt B. A prospective randomized clinical trial of intracoronary streptokinase versus coronary angioplasty therapy of acute myocardial infarction. N Engl J Med 1986; 314: 812-28.
• 9 O’Rourke M, Baron D, Keogh A, Kelly R, Nelson G, Barnes C, Raftos J, Graham K, Hillman K, Newman H, Healey J, Woolridge J, Rivers J, White H, Whitlock R, Norris R. Limitation of myocardial infarction by early infusion of recombinant tissuetype plasminogen activator. Circulation 1988; 77: 1311-5.
• 10 Rothbaum DA, Linnemeier TJ, Landin RJ, Steinmetz EF, Hillis JS, Hallam CC, Noble RJ, See MR. Emergency percutaneous transluminal coronary angioplasty in acute myocardial infarction: A 3 year experience. J Am Coll Cardiol 1987; 10: 264-72.
• 11 Serruys PW, Simoons ML, Suryapranata H, Vermeer F, Wijns W, van den Brand M, Bar F, Zwaan C, Krauss XH, Remme WJ, Res J, Verheugt FWA, van Domburg R, Lubsen J, Hugenholtz PG. the Working Group on Thrombolytic Therapy in Acute Myocardial Infarction of the Netherlands Interuniversity Cardiology Institute. Preservation of global and regional left ventricular function after early thrombolysis in acute myocardial infarction. J Am Coll Cardiol 1986; 07: 729-42.
• 12 Simoons ML, Betriu A, Col J, Von Essen R, Lubsen J, Michel PL, Rutsch W, Schmidt W, Thery C, Vahanian A, Willems GM, Arnol AER, deBono DP, Dougherty FC, Lambertz H, Meier B, Raynaud P, Sanz GA, Serruys PW, Uebis R, Van de Werf F, Wood D, Verstraete M. Thrombolysis with tissue plasminogen activator in acute myocardial infarction: No additional benefit from immediate percutaneous coronary angioplasty. Lancet 1988; I: 197-202.
• 13 SWIFT trial of delayed elective intervention versus conservative treatment after thrombolysis with anistreplase in acute myocardial infarction. Br Med J. 1991 302. 555-60.
• 14 The AIMS Trial Study Group. Effect of intravenous APSAC on mortality after acute myocardial infarction. Lancet 1988; I: 545-9.
• 15 The TIMI Research Group. Immediate vs. delayed catheterization and angioplasty following thrombolytic therapy for acute myocardial infarction. TIMI II A results. JAMA 1988; 260: 2849-58.
• 16 The TIMI Study Group. Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction. TIMI II results. N Engl J Med 1989; 320: 618-27.
• 17 Topol EJ, Califf RM, George BS, Kereiakes DJ, Abbottsmith CW, Candela RJ, Lee KL, Pitt B, Stack RS, O’Neill WW. The Thrombolysis and Angioplasty in Myocardial Infarction Study Group. A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med 1987; 317: 581-8.
• 18 Van de Werf F, Arnold AER. Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction. Br Med J 1988; 297: 1374-9.
• 19 Waller BF, Rothbaum DA, Pinkerton CA, Cowley MJ, Linnemeier TJ, Orr C, Irons M, Helmuth RA, Wills ER, Aust C. Status of the myocardium and infarct-related coronary artery in 19 necropsy patients with acute recanalization using pharmacologic (streptokinase, r-tissue plasminogen activator), mechanical (percutaneous transluminal coronary angioplasty) or combined types of reperfusion therapy. J Am Coll Cardiol 1987; 09: 785-801.
• 20 White HD, Norris RM, Brown MA, Takayama M, Maslowski A, Bass NM, Ormiston JA, Whitlock T. Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction. N Engl J Med 1987; 317: 850-5.