不同经皮冠状动脉介入治疗术支架植入时机对急性ST段抬高型心肌梗死疗效和预后的影响

Effect of different stent implantation time for percutaneous coronary intervention on efficacy and prognosis of acute ST-segment elevation myocardial infarction

目的探讨不同经皮冠状动脉介入治疗术(PCI)支架植入时机对急性ST段抬高型心肌梗死(STEMI)疗效和预后的影响。方法根据支架植入时机,将186例行PCI的急性STEMI患者分为A组127例和B组59例,其中A组在接受经皮冠状动脉球囊扩张术(PTCA)开通罪犯血管(IRA)后,即刻植入支架;B组在接受PTCA开通IRA后,积极给予抗栓治疗,患者病情稳定后复查冠状动脉造影且靶病变狭窄>50%,延迟植入支架。比较两组患者的支架植入情况、术后效果及预后。结果B组复查冠状动脉造影未见靶血管闭塞患者,发现8例患者的靶血管狭窄≤50%,免于延迟植入支架,最终B组51例患者纳入研究。B组患者植入支架数量少于A组,植入支架长度短于A组(P<0.05)。B组术后1 h内ST段回落、心肌梗死溶栓试验(TIMI)血流分级3级、心肌染色分级(MBG)3级患者比例均高于A组,慢血流/无复流和远端栓塞患者比例均低于A组(P<0.05)。B组围手术期出现主要不良心脏事件(MACE)患者比例低于A组(P<0.05),而两组间出现靶血管再次血运重建(TVR)、严重出血、再次心肌梗死和穿刺部位并发症患者比例比较,差异均无统计学意义(P>0.05)。结论在PTCA开通急性STEMI患者IRA后,延迟植入支架较即刻植入支架明显改善心肌血流动力学,减少MACE的发生,可能使患者获益更多。

Objective To explore the effect of different stent implantation time for percutaneous coronary intervention(PCI)on efficacy and prognosis of acute ST-segment elevation myocardial infarction (STEMI).Methods A total of 186 patients with acute STEMI undergoing PCI were divided into group A (127 cases)and group B(59 cases)according to stent implantation time.Patients in group A were received immediate stent implantation after percutaneous transluminal coronary angioplasty (PTCA)openning culprit vessel(IRA),while patients in group B received PTCA openning IRA at first,then antithrombotic therapies were conducted positively.After patients turned to stable condition,coronary angiography was conducted and patients with target lesion stenosis >50%were given delayed stent implantation.Stent implantation condition ,postoperative effect and prognosis between two groups were compared.Results There were no patients with target vessels occlusion and 8 patients with target vessels stenosis ≤50% which avoided stent implantation when coronary angiography was conducted for the reexamination in group B.There were 51 patients included in group B finally.The number of implanted stents in group B was less than that in group A,and the length of implanted stentts was shorter than that in group A (P <0.05).Ratios of patients with ST segment regression within 1 h,myocardial infarction thrombolysis (TIMI)blood flow grading grade 3 and myocardial blush grading(MBG)grade 3 in group B were all higher than those in group A,while ratios of patients with slow blood flow/no reflow and distal embolization were lower than those in group A (P <0.05).Ratio of patients which suffered major adverse cardiac events (MACE)during perioperative period was lower than that in group A(P <0.05),but there were no significant differences in ratios of patients which suffered revascularization(TVR),severe hemorrhage,re-myocardial infarction and complications of puncture position between two groups(P >0.05).Conclusion After PTCA has opened IRA in patients with acute STEMI,delayed stent implantation can significantly improve myocardial hemodynamics and reduce occurrence of MACE,which can benefit patients more than immediate stent implantation.