急性心肌梗死后延迟冠状动脉内支架植入治疗对左室结构和功能的影响

Effects of delayed coronary stent implantation on left ventricle in patients with acute myocardial infarction

目的：评价急性心肌梗死（AMI）后延迟冠状动脉内支架植入治疗对左室结构和功能的影响。方法：选择60例急性前壁、前间壁及广泛前壁ST段抬高的AMI后病情稳定，发病后7～14d，（平均10．2±2．5d），冠状动脉造影证实左前降支完全闭塞者，依据是否成功行冠状动脉内支架植入治疗，分为成功支架植入组和时照组，分剐于术前（心肌梗死后平均9．0±2．5d）和术后2个月，术后6个月应用超声心动图测量左心室射血分数（LVEF）、左心室舒张末容量指数（LVEDVI）、左心室收缩末期容量指数（LVESVI）和异常室壁运动积分指数（VWMA积分）。结果：AMI后2个月两组LVEF、LVEDVI、LVESVI、VWMA积分与术前比较无显著差异（P〉0．05）。6个月时两组LVEF和VWMA积分与术前和术后2个月相比无显著差异（P〉0．05）。但对照组LVEDVI，LVESVI与术前比较差异有显著性（P〈0．01，P〈0．05），且与成功植入支架组相比差异显著（P〈0．01，P〈0．05）。结论：急性前壁AMI后延迟冠状动脉内支架植入治疗能明显减少AMI后晚期的左心室重构，而对AMI后早期左心室重构的影响不大。

Objective： To assess the effect of delayed coronary stent implantation on left ventricle after acute myocardial infarction （AMI）. Methods：Sixty patients with ST-segment elevation acute interior myocardial infarction （AAMI）and with the total occluded left anterior descending coronary artery confirmed by angiogram at 10. 2 ± 2. 5 （7～ 14）days after onset were divided into successful percutanous coronary intervention （PCI）group and control group. Two dimensional echocardiogram was performed before operation （9.0±2.5 days after AMI）, 2 and 6 months after onset of AAMI respectively to detect left ventricular function and left ventricular wall motion abnormality（VWMA）. Results：left ventricular ejection fraction （LVEF）, left ventricular end-diastolic and end-systolic volume indexes （LVEDVI and LVESVI）and VWMA score were similar in two group before operation and 2 months after the onset of AAMI. LVEF and VWMA scores did not change significantly at 6 months in each group compared with those before operation and at 2 months（P〉0.05）. But LVEDVI and LVESVI were improved significantly in the successful PCI group compared with those in the control group （P〈0. 01,P〈0.05）. Conclusion： Delayed coronary stent implantation in AAMI could prevent the late phrase of left ventricular remodeling after AMI.