延迟和急诊冠状动脉介入治疗ST段抬高性心肌梗死48例疗效分析

Assessment outcomes of delayed and emergent percutaneous coronary intervention in 48 patients with ST-segment elevation myocardial infarction

目的探讨延迟和急诊经皮冠状动脉介人治疗(PCI)对ST段抬高性心肌梗死(STEMI)患者的疗效及安全性。方法48例STEMI患者,延迟PCI20例,急诊PCI28例。观察PCI术中球囊、置入支架参数及介入时间,术后TIMI血流分级、无复流现象的发生率、室性心律失常的发生率、心功能的影响以及住院期间PCI临床成功率和主要心脏不良事件(MACE,包括死亡、急性心肌梗死、再次血管重建术)发生率。结果48例患者处理病变50处,共置入55枚支架,其中药物支架(DES)46枚。临床总成功率为89.6%,急诊PCI为82.1%,延迟PCI为100%。住院期间死亡率为6.2%。与急诊PCI比较,延迟PCI选用支架长度增加(27.10±4.10%和23.00±5.86,P<0.01),减少室性心律失常的发生(10%和42.8%,P<0.05),能够恢复TIMI血流3级(100%和85.7%),无复流现象减少(0和10.7%),能改善心功能(53.4±4.2和54.7±6.3)以及减少住院期间MACE事件发生(0和17.8%,P>0.05)。结论选择最佳时期行延迟PCI开通梗死相关血管是安全可行的。但DES时代晚期开通梗死相关动脉(IRA)的远期结果尚待进一步的临床研究。

Objective To observe the clinical effects and safeness of delayed and emergent percutaneous coronary intervention （PCI） for patients with ST-segment elevation myocardial infarction （STEMI）. Methods In total of 48 patients with STEMI, 20 patients underwent delayed PCI and 28 patients underwent emergent PCI. The parameter of balloon, stent and the time of PCI were observed; After PCI Thrombolysis in Myocardial Infarction （TIMI） flow grade, no- flow phenomenon, ventricular arrhythmia, heart function, the incidence of in-hospital clinical success of PCI and MACE were observed. Results 50 branches of the infarct-related coronary artery （IRA） was intervened in 48 patients who were implanted 55 stents including 46 drug-eluting stents （DES）. Clinical success （angiographic success and freedom from major adverse cardiac events） was 89.6% for the entire PCI, 82.1% for the emergent PCI group, and 100% for the delayed PCI group. Overall, in-hospital mortality for the entire PCI was 6.2%. Compared with emergent PCI, Delayed PCI increased the length of implanted stents （27.10± 4.10% vs 23.00±5.86,P〈0.01 ）, decreased ventricular arrhythmia （10% vs 42.8%,P〈0.05）, recovered TIMI 3 flow grade （100% vs 85.7%）, decreased no-flow phenomenon （0 vs 10.7%）, improved heart function （53.4±4.2 vs 54.7±6.3） and decreased the incidence of in-hospital MACE （0 vs 17.8%,P〉0.05）. Conclusion Delayed PCI for IRA in the optimal time is safe and feasible. But in the era of DES further clinical studies are needed to confirm long-term outcomes of delayed PCI for IRA.