延迟冠状动脉介入治疗对急性心肌梗死患者预后的影响

Clinical assessment of benefits of delayed percutaneous transluminal coronary intervention in patients with acute myocardial infarction

目的探讨延迟经皮冠状动脉介入治疗(PC I)对急性心肌梗死(AM I)患者预后的影响。方法对38例ST段抬高的AM I患者经静脉溶栓后常规行延迟PC I(延迟组),然后与经静脉溶栓后药物保守治疗(对照组)的34例患者进行对比分析,观察住院期间和随访6个月时的临床不良事件和超声心动图的变化。结果与保守治疗比较,常规施行延迟PC I可以降低住院期间的病死率(0%vs15%,P<0.05),缩短平均住院时间(15 dvs28 d,P<0.05),减少住院期间心绞痛发作(5%vs35%,P<0.05)及再次心肌梗死(0%vs9%,P<0.05);还可以明显降低6个月病死率(3%vs12%,P<0.05)和再住院率(8%vs26%,P<0.05),防止左心室进一步重构,改善患者心脏功能。结论常规施行延迟PC I可以提高AM I患者住院期间和6个月的治疗效果,改善临床预后。

AIM To evaluate the role of routine delayed percutaneous coronary intervention （PCI） after thrombosis in the management of patients with ST-segment elevation myocardial infarction （STEMI）. METHODS Thirty-eight patients with STEMI who underwent routine delayed PCI after thrombosis （therapy group）and 34 patients with STEMI who were given conservative strategy after thrombosis （control group） were enrolled in this study and were compared in major adverse clinical events （MACE）and cardiac structure and function by echocardiography during hospitalized period and 6-month follow-up. RESULTS Compared with conservative strategy after thrombosis, routine delayed PCI after thrombosis decreased the inhospital mortality （0% vs 15% ） , shortened the average hospital stay time （ 15 d vs 28 d） , prevented recurrent angina （5% vs 35% ）and reinfarction （0% vs 9% ） , produced lower mortality （3% vs 12% ）and rehospitalization （8% vs 26% ） during the follow-up period and prevented further left ventricle remodeling. CONCLUSION Routine delayed PCI after thrombosis may prevent MACE and improve immediate results and 6-month prognosis of patients with STEMI.