文档介绍：Combination Lytic Therapy in Acute Myocardial Infarction
C. Michael Gibson, .
Pathophysiology bination Therapy in AMI
*Gibson et al. J Am Coll Cardiol. 1995;25:582-589.
Gibson et al. Circulation. 2001;103:2550-2554.
Combination Therapy
Thrombus
% Stenosis
Minimum Diameter
Epicardial Flow
Myocardial Blush
ST Resolution
Myocardial Flow
Facilitates PCI
Reduces Reinfarction*
Recent Clinical Trials
Unfractionated heparin
Enoxaparin
Unfractionated heparin
Enoxaparin
Abciximab
Abciximab
None
None
ENTIRE
ACC/AHA heparin dose
Low-dose heparin
Enoxaparin
None
Abciximab
None
ASSENT-3
Standard-dose heparin
Low-dose heparin
None
Abciximab
50% TNK-tPA
50% TNK-tPA
100% TNK-tPA
100% TNK-tPA
100% TNK-tPA
50% TNK-tPA
100% TNK-tPA
100% r-PA
50% r-PA
GUSTO-V
Anticoagulant
GP IIb/IIIa
Receptor Inhibitor
Lytic
Trial
Clinical Trials: Ongoing
Low-dose heparin
Low-dose heparin
Low-dose heparin
Eptifibatide
Eptifibatide
Eptifibatide
50% TNK-tPA
75% TNK-tPA
100% TNK-tPA
INTEGRITI
Low-dose heparin
Low-dose heparin
Low-dose heparin
Tirofiban
Tirofiban
Tirofiban
50% TNK-tPA
75% TNK-tPA
100% TNK-tPA
FASTER
Anticoagulant
GP IIb/IIIa
Receptor Inhibitor
Lytic
Trial
54%
32%
GUSTO-I: A 20% Increase in TIMI Grade 3 Flow is Needed to Yield a 1% Mortality Reduction
The GUSTO Angiographic Investigators. N Engl J Med. 1993;329:1615-1622.
0
30
50
60
40
20
% TIMI Grade 3 Flow
t-PA
SK
10
t-PA
5
%
%
SK
8
7
6
TIMI Grade 3 Flow – Pooled Data From Dose Confirmation Phases of Recent Trials
0
40
80
100
60
20
% Patients With TIMI Grade 3 Flow
GUSTO-I
90 min
T14 t-PA
90 min
T14 r-PA
90 min
SPEED
60-90 min
INTRO-AMI
60 min
Pooled
60-90 min
54
73
70
47
40
56
78
73
54
56
64
292
63
87
98
81
329
58
88
100
75
321
Lytic alone
Combination
SPEED: Results of Dose-Confirmation Phase
There was a % improvement in the rate of TIMI Grade 3 flow
If a 20% improvement is required to improve mortal