延迟PCI改善急性心肌梗死左室重构及缩小梗死面积的效果

Effect on Ventricular Restructure and Infarct Size of ST-segment Elevation Acute Myocardial Infarction Treated by Delayed PCI

目的 探讨延迟PCI治疗急性心肌梗死对改善左室重构和缩小心肌梗死面积的效果.方法 312例ST段抬高性急性心肌梗死患者,分为直接PCI治疗组65例,延迟PCI治疗组81例,尿激酶静脉溶栓治疗组74例,药物保守治疗组92例.全部患者随访6～36个月,观察住院期间和随访期间的主要心脏事件、复合终点事件和超声心动图变化及利用QRS计分评估梗死范围的变化.结果 1）延迟PCI组平均住院时间为（14.1±11.7）d,显著少于静脉溶栓（20.5±8.4）d和内科药物治疗组（19.2±9.4）d（P＜0.05）;而与直接PCI组的住院时间相同（P＞0.05）.2）延迟PCI的复合终点事件发生率显著少于静脉溶栓和内科药物治疗组（P＜0.05）;与直接PCI组比较,无显著差异（P＞0.05）.3）本组随访6～36个月,平均随访（21.5±4.6）个月时.随访期间,延迟PCI组的心力衰竭及复合终点事件的发生率显著低于静脉溶栓组和内科药物治疗组（P＜0.05）.4）超声心动图随访结果显示,在住院期间和随访期间,延迟PCI组的LVEF显著高于非PCI治疗组（P＜0.05）,而延迟PCI组的LAD和LVDd均显著小于非PCI延迟组.5）延迟PCI组的心肌梗死范围回缩率（0.376±0.138）显著大于内科药物治疗组（0.173±0.094）（P＜0.05）,而与直接PCI组（0.413±0.169）和溶栓组（0.289±0.177）相似.结论 延迟PCI治疗急性心肌梗死可改善患者的左室重构,缩短平均住院时间,减少住院期间和随访期间的心脏事件、复合终点事件发生率,使心肌梗死面积缩小.

Objective To evaluate the ventricular restructure and infarct size of ST-segment elevation acute myocardial infarction（STEMI）treated by delayed PCI. Methods Three hundred and twelve patients with STEMI were divided into four groups, sixty-five patients underwent immediate PCI; eighty-one patients underwent delayed PCI; seventy-four patients underwent intravenous thrombolytic therapy; Ninety-two patients underwent physical medical therapy. All patients were investigated during in-hospital and follow-up regarding major adverse cardiac events and the left ventricular restructure by echocardiography and infarct size estimated by the QRS point system. Results 1）Average hospital stay in delayed PCI was（14.1 ± 11.7） days, and was significantly shorter than that in thrombolytic group and physical medical therapy group（P〈 0.05）, but was similar to that in immediate PCI group. 2）In-hospital major adverse cardiac events in delayed PCI were significantly less than those in thrombolytic and physical medical therapy group（P 〈 0.05） ; but compared with immediate PCI group, there was no significant difference（P 〉 0.05）. 3）During follow-up period（mean 21.5 ± 4.6 months）, compared with thrombolytic and physical medical therapy, delayed PCI decreased heart failure and major adverse cardiac events（P 〈 0.05）. 4）The left ventricular EF in delayed PCI group was significantly higher than that in thrombolytic group and physical medical therapy group （P 〈 0.05）; The LVDd, LAD in delayed PCI group was significantly less than that in thrombolytic and physical medical therapy group. 5） Decrease rate of QRS score-estimated infarct size by initial and follow-up electrocardiograms in delayed PCI was greater compared with the physical medical group and similar to immediate PCI group and thrombolytic group. Conclusion Delayed PCI may effectively improve the left ventricular restructure and reduce the mean in-hospital stay, and decrease the rate of major adverse cardiac events during hospitalization and follow-up and infarct size that the acute ST-segment elevation myocardial infarction was treated by delayed PCI.