急性心肌梗死后延迟冠状动脉内支架植入术的临床分析

Analysis of Clinical Outcome of Late Coronary Stunting in Patients with Acute Myocardial Infarction

目的通过评价急性心肌梗死(AMI)后延迟冠状动脉介入治疗(PCI)对左室重塑、心功能的影响,并分析随访资料,探讨AMI延迟PCI的临床意义。方法25例PCI病人为治疗组,同期未行PCI的19例病人为对照组,于基线、1个月及6个月3个时间点进行同位素心肌灌注显像检查,同时进行临床资料随访。结果①两组间对左室舒张末容积(EDV)、左室收缩末容积(ESV)及左室射血分数(LVEF)无统计学意义,且不同时间段比较,EDV、ESV及LVEF在不同时间段间无统计意义;EDV、ESV、LVEF各组的不同时间段与治疗方法间无交互作用。②临床事件随访时间6个月～16个月,治疗组复合事件(包括死亡、心肌梗死、脑卒中、心力衰竭、心绞痛等)发生率较低(24.0%VS57.9%P=0.02)。结论AMI后延迟PCI治疗的心脏复合事件发生率较低,但对左室重塑并未显示有利作用,其意义需要进一步大规模临床试验的观察。

Objective To explore the possible clinical implication of late coronary stunting by evaluating the left ventricular remodeling and clinical events. Methods The clinical outcome was compared between patients （pts） with （25 pts,stenting group） and without （19 pts, control group） late coronary stenting after AMI. The data of 99Tcm - MIBI myocardial imaging were collected at baseline,one month and six months following the stunting to estimate the left ventricular size and function. Results 1. Left ventricular size and function.The left ventricular end - diastolic volume（EDV, P = 0. 825 ）, end - systolic volume（ESV, P =0.973） and ejection fraction（EF, P = 0. 737） were similar between the two groups,and no significant changes in EDV（P = 0. 152）, ESV（P = 0. 164） and EF（P = 0.22） were observed for two groups during the time interval of followup. 2. Clinical events： During the follow - up duration （10.4 ± 3.5 months）,combined event rate （including death, myocardial infarction, stroke, heart failure,angina pectoris） favors a policy of coronary stunting therapy（24.0% VS 57.9 %, P = 0.02）. Conclusion Late coronary stunting following AMI is an effective and safe therapy. There are less combined event rates in stunting group than that in control group. The implication of late PCI after AMI, especially the effect on left ventricular remodeling,needs to be further tested.