急性前壁心肌梗死后延迟开通梗死相关动脉对晚期心功能的影响

Effects of delayed opening of infarct-related artery on late heart function in patients with acute anterior myocardial infarction

目的探讨急性前壁心肌梗死(AAMI)后经皮冠脉介入治疗(PCI)延迟开通梗死相关动脉(IRA)对患者晚期心功能的影响。方法选择32例急性前壁、前间壁及广泛前壁Q心肌梗死后病情稳定后,在发病2～18天, 平均7．4±3．8天,行冠脉造影显示左前降支闭塞或严重狭窄,成功行PCI为治疗组,病情不允许行PCI或未经介入诊疗者77例为对照组,分别在急性期、术后6个月行超声心动图检查,随访左室功能、左房、左室大小与急性期 (3周)对照,显示左室舒张末期左右径减小、收缩功能、舒张功能改善,其中舒张功能改善差异有统计学意义。随访 6个月内心力衰竭事件发生率治疗组为3．2％,对照组为22．0％,但差异无统计学意义。结论 AAMI后延迟开通梗死相关动脉,能明显改善左室重构及心功能,可能有利于减少远期心力衰竭的发生。

Objective： To assess the effect of delayed opening infracted - related artery （IRA） by percutanous coronany intenvention （PCI） on the late heart function after acute anterior myocardial infarction （AAMI ）. Methods. Thirty two patients with acute Q- wave AAMI and with occlude IRA confirmed by coronary angiogram at 7.4±3.8 （2- 18 ） days after the onset were divided into the successful group, and the other seventy eight patients into control group （not receiving PCI or the PCI not re- opened）. Two dimension echocardiogram was performed at acute phase （about 3 weeks） and 6 months after onset of AAMI respectively to detect the left ventricular function and its dimension. The total congestive heart failure events were recorded during the 6 months. Results： Left ventricular dimension, left ventricular ejection fraction（LVEF） and F/A were similar in the two groups at acute phase after the onset of AAMI, Left ventricular dimension was significantly smaller and LVEF and E/A were siginificantly better in the PCI group than those in the control group （ P 〈 0.05 ）. The rate of congestive heart failure events was 3.2 % in successful group and 22.0 % in the control group （P 〉0.05） respectively. Conclusion： Delayed opening of IRA in patients with AAMI can prevent the late phase ventricular remodeling and improve left ventricular function.