选择性经皮冠状动脉介入治疗及静脉溶栓治疗对老年急性心肌梗死患者远期预后的影响

Effects of selective percutaneous coronary intervention and thrombolytic therapy on the long-term prognosis of acute myocardial infarction in elderly patients

目的:探讨静脉溶栓及静脉溶栓后选择性经皮冠状动脉介入治疗(PC I)对老年急性心肌梗死(AM I)患者远期预后的影响。方法结果结论方法:选择确诊AM I住院的连续患者114例,只接受静脉溶栓60例为药物组,54例静脉溶栓后平均(9.1±2.4)天行PC I为手术组,分别于溶栓后及PC I后3个月、6个月及12个月随访主要心脏不良事件(MACE),MACE定义为死亡、再梗死、再发心绞痛、严重心力衰竭。随访复查超声心动图,计算左室的整体室壁运动指数以评价左室的节段收缩功能,根据左室收缩末容积和舒张末容积计算左室射血分数。结果:两组患者住院期间无死亡及心绞痛复发,手术组血管造影和操作成功率均为100%,无操作相关心肌梗死、急诊CABG。临床随访期间死亡率手术组显著低于药物组(P<0.05),因不稳定性心绞痛或心绞痛复发再次入院的患者手术组显著少于药物组(P<0.05),因心力衰竭或心力衰竭加重再次入院在手术组和药物组差异无统计学意义(P≈0.06),两组总的临床终点事件发生率分别为22.22%和63.15%,手术组明显低于药物组,差异有统计学意义(P<0.01)。结论:老年AM I患者静脉溶栓后选择性PC I能改善其远期预后。

Objective：To evaluate the effect of selective percutaneous coronary intervenlion （PCI） and thrombolytic therapy on the long- term prognosis of acute myocardial infarction （AMI） in elderly patients. Methods： Results： Conclusion： Methods：114 patients with AMI were randomly treated with thrombolytic therapy or with selective PCI. 60 of 114 patients received thrombolytic therapy only （group A）. Selective PCI was performed at （9.1±2.4） days after thrombolytic therapy in the other 54 patients （group B）. The patients was followed up at 3 months,6 months, 12 months after thrombolytic therapy or selective PCI. Major adverse cardiac events （MACE） defined as cardiac death, myocardial reinfarction,recurrent angina, congestive heart failure . All patients were followed up with echocardiography. The left ventricular regional systolic function was evaluated with wall motion score index（WMSI）. Left ventricular ejection fraction was calculated by left ventricular end - systolic volume and left ventricular end -diastolic volume. Results： There was no cardiac death and recurrent angina in hospital stay in two groups. The success rate of coronary angiography and PCI was 100% . No severe complication such as AMI and acute CABG occurred. The mortality in group B was more lower than group A （P 〈 0.05）. There was no great differents between two groups in the rate of congestive heart failure （P 〉 0.05 ）. The rate of MACE was 22. 22% in group B and 63.15% in group A （P 〈0.01 ）. Conclusions： Selective PCI after thrombolytic therapy could improve the long - term prognosis of AMI in elderly patients.