CARESS研究：溶栓后PCI降低死亡率 应强制执行

CARESS - PCI after thrombolysis lives on and should be considered mandatory

Immediate transfer for PCI after the start of thrombolysis reduced death in ST elevated MI patients, the CARESS study found. Current practice in most European hospitals is to administer thrombolytics and only to refer patients for PCI if they show no evidence of reperfusion.

In the CARESS study, which took place in Poland, Italy and France, 600 MI patients were randomised at the time of admission either to receive urgent transfer to ancillary PCI after thrombolysis, or to receive medical treatment with referral for PCI only if they experienced persistent ST elevation after 90 minutes of treatment, chest pain or haemodynamic compromise. Overall, 35.7% of those who received thrombolysis alone were subsequently referred for PCI. Results at 30 days showed that 4.1% of patients in the group who had immediate transfer for PCI experienced the combined end-point of death and MI complications, compared to 11.1 % in the group who only had thrombolytic therapy (p<0.001).

Additional findings showed that the average length of hospital stay was seven days in the facilitated PCI group and nine days in the thrombolysis-alone group (p<0.001).

“The study suggests PCI guidelines need to be changed so that all patients are referred for PCI,” principal investigator Carlo di Mario (Imperial College, London, UK) said at the Hot Line Session. Discussant Freek Verheugt (Nijmegen, NL) said that, taken together with the earlier GRACIA-1, SIAM-3 and CAPITAL-MI trials, CARESS confirms early PCI should now routinely follow thrombolytic therapy. “But randomised trials are needed to determine whether PCI works best within 2.5 hours - as in CARESS - or if patients can wait 17 hours after thrombolytic therapy - as in GRACIA,” he said.



溶栓后PCI可降低死亡率，应强制执行
CARESS研究发现开始溶栓治疗后立即转入PCI治疗可以降低ST段抬高的MI病人死亡率。而目前欧洲大部分医院中的病人只有接受溶栓治疗后无再灌注证据时才接受PCI治疗。
CARESS研究纳入波兰、意大利、法国三个国家600例MI病人。病人入院时随机分为两组：溶栓后紧急PCI治疗组和内科治疗而当病人出现治疗90分钟后持续ST段抬高、胸痛或血液动力学改变时接受PCI治疗组。所有病人中，35.7％单独接受溶栓治疗的病人随后再次接受PCI。30天后结果显示：溶栓后紧急PCI治疗组中4.1％的病人出现死亡或MI并发症的终点指标，而只接受溶栓治疗组中11.1％病人达到终点指标。
此外溶栓后紧急PCI组的平均住院天数为7天而单纯溶栓治疗组为9天（p<0.001）。
此项研究主要负责人英国伦敦帝国大学Carlo di Mario教授在Hot Line 会议中说：这项研究建议PCI指南进行修改以便所有的病人均接受PCI治疗。Freek Verheugt (Nijmegen, NL)教授说到，与早期的GRACIA-1, SIAM-3 and CAPITAL-MI 研究联系起来，CARESS研究证实了溶栓后应常规进行PCI治疗，但是需要更进一步随机化的研究证实PCI的时机，是CARESS研究中报道的2.5小时以内，还是GRACIA研究中报道的溶栓后17小时以后更好。