直接经皮冠状动脉介入治疗对有无梗死前心绞痛患者心室重构和心功能的影响

Direct percutaneous coronary intervention on left ventricular remodeling and function in acute myocardial infarction patients with or without preinfarction angina pectoris

目的 探讨直接经皮冠状动脉介入治疗 (PCI)对有无梗死前心绞痛的急性心肌梗死 (AMI)患者心室重构和心功能的影响。方法 37例首次AMI患者 ,按有无梗死前心绞痛分为 :有梗死前心绞痛者 (A组 ) 2 4例 ;无梗死前心绞痛者 (B组 ) 13例。所有患者均在发病 6小时内行直接PCI术 ,术后 2周、12周、2 4周分别行超声心动图和99mTc心血池显像观察左心室容积、心功能变化。结果 ① 12周、2 4周与 2周比较 ,所有患者左室舒张末容积指数(LVEDVI)和左室收缩末容积指数 (LVESVI)均显著降低 (P <0 .0 1) ;在 12周、2 4周时 ,A组均低于B组 (P <0 .0 5 )。② 12周、2 4周与 2周比较 ,A组左室射血分数 (LVEF)显著提高 (P <0 .0 5 ) ;在 12周和 2 4周时 ,A组LVEF均高于B组 (P <0 .0 5 )。结论 直接PCI治疗可有效抑制心室重构 ,改善心室功能 ,而梗死前心绞痛组的这种作用明显优于无梗死前心绞痛组。

Objective To evaluate effects of direct percutaneous coronary intervention(PCI) on left ventricular remodeling and function in acute myocardial infarction(AMI) patients with or without preinfarction angina pectoris.Method Thirty-seven patients with first AMI were divided into two groups: preinfarction angina(group A,n=24); no preinfarction angina(group B,n=13).All the patients undervent direct PCI within 6 hours after onset of AMI.At 2nd week,12th week,24th week after PCI,echocardiogram and 99m Tc gated cardiac blood pool image were performed to observe changes of left ventricular volume and left ventricular function.Results ①Both left ventricular end diastolic volume index and left ventricular end systolic volume index in all the patients were significantly decreased at 12th week and 24th week as compared with those at 2nd week(P< 0.01 );At 12th week and 24th week,both indexes were lower in group A than those in group B (P< 0.05 ).② Left ventricular ejection function (LVEF) of group A was significantly improved at 12th week and 24th week as compared with that at 2nd week(P< 0.05 ).At 12th week and 24th week,LVEF in group A was higher than that in group B(P< 0.05 ).Conclusion Direct PCI could have better effect on preventing left ventricular remodeling and improving left ventricular function.