Background: Intravenous thrombolysis with rt-PA improves outcome in acute ischemic stroke. In a prospective study we analyzed the annual frequency of rt-PA treatment, its safety, and early clinical outcome. Methods: A...Background: Intravenous thrombolysis with rt-PA improves outcome in acute ischemic stroke. In a prospective study we analyzed the annual frequency of rt-PA treatment, its safety, and early clinical outcome. Methods: All patients admitted to our stroke unit (SU) from 1998 to 2003 were registered in a prospective data base. Documented data included patient age, sex, time interval until admission, initial therapy (e. g., thrombolysis), death, intracerebral hemorrhage, other complications, and score on the National Institute of Health Stroke Scale (NIHSS). Results: From 1998 to 2003, a total of 112 patients were treated with systemic thrombolysis. The number of acute stroke patients admitted within 2.5 hours and therefore eligible for thrombolysis did not substantially change between 1998 and 2003. From 1998 to 2001 the percentage of acute stroke patients that received rt-PA was stable (12.6- 16.9 % ). This percentage increased in 2002 (29.6 % , p < 0.05) and, again, in 2003 (42.1 % , p < 0.01). Of all treated patients, two developed symptomatic intracerebral hemorrhage (1.8 % ) and five died three to seven days after thrombolysis (4.5 % ). The NIHSS score of patients receiving rt-PA significantly decreased during the acute treatment phase (14.2 ± 5.1 to 8.0 ± 5.9, p < 0.001). A comparison of single years revealed that this NIHSS score reduction was stable. Conclusion: In our selected patients, the proportion of acute stroke patients treated with systemic thrombolysis increased almost three-fold from 1998 to 2003. This may be explained by protocol modifications and growing experience with the use of rt-PA. Our data demonstrate that increased use of rt-PA in acute stroke patients can be achieved without adversely affecting safety or clinical benefit.展开更多
Objective: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction(STEMI) in Switzerland. Design: National prospective multicentre registry, AMIS Plus(acute myocardial infarction a...Objective: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction(STEMI) in Switzerland. Design: National prospective multicentre registry, AMIS Plus(acute myocardial infarction and unstable angina in Switzerland), of patients admitted with acute coronary syndromes. Setting: 54 hospitals of varying size and capability in Switzerland. Patients: 7098 of 11 845 AMIS Plus patients who presented with ST segment elevation or left bundle branch block on the ECG at admission. Main outcome measures: In-hospital mortality and its predictors at admission by multivariate analysis. Results: The proportion of patients treated by primary percutaneous coronary intervention(PCI) progressively increased from 1997 to 2002, while the proportion with thrombolysis or no reperfusion decreased(from 8.0%to 43.1%, from 47.2%to 25.0%, and from 44.8%to 31.4%, respectively). Overall in-hospital mortality decreased over the study period from 12.2%to 6.7%(p< 0.001). Main in-hospital mortality predictors by multivariate analysis were primary PCI(odds ratio(OR) 0.52, 95%confidence interval(CI) 0.33 to 0.81), thrombolysis(OR 0.63, 95%CI 0.47 to 0.83), and Killip class III(OR 3.61, 95%CI 2.49 to 5.24) and class IV(OR 5.97, 95%CI 3.51 to 10.17) at admission. When adjusted for the year, multivariate analysis did not show PCI to be significantly superior to thrombolysis for in-hospital mortality(OR 1.2 for PCI better, 95%CI 0.8 to 1.9, p=0.42). Conclusion: Primary PCI has become the preferred mode of reperfusion for STEMI since 2002 in Switzerland, whereas use of intravenous thrombolysis has decreased from 1997 to 2002. Furthermore, there was a major reduction of in-hospital mortality over the same period.展开更多
The aim of this study is to test the patency rate and safety of the accelerated streptokinase dose regimen for coronary thrombolysis compared with the conventional one. One hundred and four patients enterring three ho...The aim of this study is to test the patency rate and safety of the accelerated streptokinase dose regimen for coronary thrombolysis compared with the conventional one. One hundred and four patients enterring three hospitals up to 12 hours after the onset of definite acute myocardial infarction were randomizely treated with intravenous accelerated streptokinase dose regimen ( 1. 5 million units/30 min) (group A, 47 cases) and conventional dose regimen ( 1. 5 million units/60 min) (group B , 57 casese). The reperfusion rate of infarct-related arteries determined by clinical evidence of reperfusion was 76. 6% (36/47) in group A VS 61. 4% (35/57) in group B. There was significant difference in reperfusion rates among patients within 6 hours after the onset of chest pain : 87. 9% (29/33) in group A VS 67. 4 (29/43) in group B(P<0. 05 ). The incidence of mild bleeding , allergic reaction , hypotension was 12. 8 % ( 6/47 ) , 4. 3 % ( 2/47 ) , 12. 8 ( 6/47 ) respectively in group A vs 21. 1 ( 12/57 ) , 3. 5 (2/57) . 17. 5 % ( 10/57) respectively in group B. Compared to conventional dose regimen, intravenous accelerated streptokinase dose regimen for coronary thrombolysis seems to improve reperfusion rate markedly without increasing adverse events such as bleeding , allergic reaction and hypotension. It suggests that accelerated streptokinase therapy deserves more extensive investigation.展开更多
文摘Background: Intravenous thrombolysis with rt-PA improves outcome in acute ischemic stroke. In a prospective study we analyzed the annual frequency of rt-PA treatment, its safety, and early clinical outcome. Methods: All patients admitted to our stroke unit (SU) from 1998 to 2003 were registered in a prospective data base. Documented data included patient age, sex, time interval until admission, initial therapy (e. g., thrombolysis), death, intracerebral hemorrhage, other complications, and score on the National Institute of Health Stroke Scale (NIHSS). Results: From 1998 to 2003, a total of 112 patients were treated with systemic thrombolysis. The number of acute stroke patients admitted within 2.5 hours and therefore eligible for thrombolysis did not substantially change between 1998 and 2003. From 1998 to 2001 the percentage of acute stroke patients that received rt-PA was stable (12.6- 16.9 % ). This percentage increased in 2002 (29.6 % , p < 0.05) and, again, in 2003 (42.1 % , p < 0.01). Of all treated patients, two developed symptomatic intracerebral hemorrhage (1.8 % ) and five died three to seven days after thrombolysis (4.5 % ). The NIHSS score of patients receiving rt-PA significantly decreased during the acute treatment phase (14.2 ± 5.1 to 8.0 ± 5.9, p < 0.001). A comparison of single years revealed that this NIHSS score reduction was stable. Conclusion: In our selected patients, the proportion of acute stroke patients treated with systemic thrombolysis increased almost three-fold from 1998 to 2003. This may be explained by protocol modifications and growing experience with the use of rt-PA. Our data demonstrate that increased use of rt-PA in acute stroke patients can be achieved without adversely affecting safety or clinical benefit.
文摘Objective: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction(STEMI) in Switzerland. Design: National prospective multicentre registry, AMIS Plus(acute myocardial infarction and unstable angina in Switzerland), of patients admitted with acute coronary syndromes. Setting: 54 hospitals of varying size and capability in Switzerland. Patients: 7098 of 11 845 AMIS Plus patients who presented with ST segment elevation or left bundle branch block on the ECG at admission. Main outcome measures: In-hospital mortality and its predictors at admission by multivariate analysis. Results: The proportion of patients treated by primary percutaneous coronary intervention(PCI) progressively increased from 1997 to 2002, while the proportion with thrombolysis or no reperfusion decreased(from 8.0%to 43.1%, from 47.2%to 25.0%, and from 44.8%to 31.4%, respectively). Overall in-hospital mortality decreased over the study period from 12.2%to 6.7%(p< 0.001). Main in-hospital mortality predictors by multivariate analysis were primary PCI(odds ratio(OR) 0.52, 95%confidence interval(CI) 0.33 to 0.81), thrombolysis(OR 0.63, 95%CI 0.47 to 0.83), and Killip class III(OR 3.61, 95%CI 2.49 to 5.24) and class IV(OR 5.97, 95%CI 3.51 to 10.17) at admission. When adjusted for the year, multivariate analysis did not show PCI to be significantly superior to thrombolysis for in-hospital mortality(OR 1.2 for PCI better, 95%CI 0.8 to 1.9, p=0.42). Conclusion: Primary PCI has become the preferred mode of reperfusion for STEMI since 2002 in Switzerland, whereas use of intravenous thrombolysis has decreased from 1997 to 2002. Furthermore, there was a major reduction of in-hospital mortality over the same period.
文摘The aim of this study is to test the patency rate and safety of the accelerated streptokinase dose regimen for coronary thrombolysis compared with the conventional one. One hundred and four patients enterring three hospitals up to 12 hours after the onset of definite acute myocardial infarction were randomizely treated with intravenous accelerated streptokinase dose regimen ( 1. 5 million units/30 min) (group A, 47 cases) and conventional dose regimen ( 1. 5 million units/60 min) (group B , 57 casese). The reperfusion rate of infarct-related arteries determined by clinical evidence of reperfusion was 76. 6% (36/47) in group A VS 61. 4% (35/57) in group B. There was significant difference in reperfusion rates among patients within 6 hours after the onset of chest pain : 87. 9% (29/33) in group A VS 67. 4 (29/43) in group B(P<0. 05 ). The incidence of mild bleeding , allergic reaction , hypotension was 12. 8 % ( 6/47 ) , 4. 3 % ( 2/47 ) , 12. 8 ( 6/47 ) respectively in group A vs 21. 1 ( 12/57 ) , 3. 5 (2/57) . 17. 5 % ( 10/57) respectively in group B. Compared to conventional dose regimen, intravenous accelerated streptokinase dose regimen for coronary thrombolysis seems to improve reperfusion rate markedly without increasing adverse events such as bleeding , allergic reaction and hypotension. It suggests that accelerated streptokinase therapy deserves more extensive investigation.
