挪威学者研究比较了需远距离转运的急性心肌梗死溶栓患者二种PCI手术时机对患者预后的影响，一种是溶栓后立即转运到有条件医疗中心做PCI，另一种是溶栓后如果有心肌缺血症状或病情恶化再转诊做PCI。研究入选住在郊区需90min以上转运时间的急性ST段抬高心肌梗死患者，在替奈普酶治疗的同时，随机分为立即转院组和症状恶化驱使转院组。研究发现，立即转院组12个月死亡率、再梗率、脑卒中率较症状恶化驱使转院组明显降低。辽宁省人民医院心血管内科侯爱洁

　　立即转院组实际上是被动易化PCI，该研究实际上比较了没有条件PCI患者溶栓后转运PCI及保守治疗的结果，证明溶栓后转运PCI终点事件低于保守治疗，但在有条件PCI的患者溶栓后PCI(即易化PCI)在中国《经皮冠状动脉介入治疗指南(2009)》中，被列为III类适应症。所以，在有条件PCI的中心，直接PCI为首选，无条件PCI且转运时间90min以上的中心应在溶栓后立即转运到有条件中心PCI治疗。

　　J Am Coll Cardiol, 2010; 55:102-110

　　Objectives: The goal of this study was to compare a strategy of immediate transfer for percutaneous coronary intervention (PCI) with an ischemia-guided approach after thrombolysis in patients with very long transfer distances to PCI.

　　Background: Thrombolysis remains the treatment of choice in ST-segment elevation myocardial infarction (STEMI) when primary PCI cannot be performed within 90 to 120 min. The optimal treatment after thrombolysis is still unclear.

　　Methods: A total of 266 patients with acute STEMI living in rural areas with more than 90-min transfer delays to PCI were treated with tenecteplase, aspirin, enoxaparin, and clopidogrel and randomized to immediate transfer for PCI or to standard management in the local hospitals with early transfer, only if indicated for rescue or clinical deterioration. The primary outcome was a composite of death, reinfarction, stroke, or new ischemia at 12 months, and analysis was by intention to treat.

　　Results: The primary end point was reached in 28 patients (21%) in the early invasive group compared with 36 (27%) in the conservative group (hazard ratio: 0.72, 95% confidence interval: 0.44 to 1.18, p = 0.19). The composite of death, reinfarction, or stroke at 12 months was significantly reduced in the early invasive compared with the conservative group (6% vs. 16%, hazard ratio: 0.36, 95% confidence interval: 0.16 to 0.81, p = 0.01). No significant differences in bleeding or infarct size were observed.

　　Conclusions: Immediate transfer for PCI did not improve the primary outcome significantly, but reduced the rate of death, reinfarction, or stroke at 12 months in patients with STEMI, treated with thrombolysis and clopidogrel in areas with long transfer distances.