72例急性心肌梗死采用直接PCI与延迟PCI治疗的临床观察

Safety efficacy comparison between direct or late elective percutaneous coronary intervention in 72 patients with acute myocardial infarction

目的观察急诊直接经皮冠状动脉介入治疗（PCI）和静脉溶通后行延迟PCI冠脉血运重建术治疗急性心肌梗死（AMI）的疗效及并发症。方法因AMI住院并接受PCI治疗者72例,急诊直接PCI者20例,溶栓后梗死相关血管开通行延迟PCI者52例,直接PCI者仅处理梗死相关血管,延迟PCI者除处理梗死相关血管外,对严重狭窄的非梗死相关血管也同时进行了处理。术后随访12～24个月,观察心血管事件的发生情况。结果直接PCI和延迟PCI的梗死相关血管均成功开通血运重建,手术成功率100%。术中梗死相关冠脉血运重建术后即刻血管慢复流的发生率直接PCI组较延迟PCI组高（P〈0.05）,术后随访期间,7例术后6个月内发生心绞痛,5例为直接PCI,2例为延迟PCI。无再梗和死亡病例发生。结论PCI是治疗AMI的有效方法,手术成功率高,并发症少,急诊直接PCI术中冠脉血管重建术后即刻血管慢复流的发生率较延迟PCI者高,选择性的对病变血管采取PCI能取得非常好的疗效。

Objective To evaluate the efficacy and complications of different plans of percutaneous coronary revascularization in acute myocardial infarction（AMI）. Methods Total 72 patients with AMI received 2 different plans of percutaneous coronary intervention （PCI）, direct PCI in 20 patients, and late elective PCI in 52 patients who were successfully angiograghic reperfusion after intravenous thrombolysis. They were followed up for 24 months, and cardiovascular events were observed. Results The infarct related arteries were successful reopened in all 72 patients. In some elective PCI patients, the severe stenotic non-infarct related arteries were completely dilated. The rates of slow-flow phenomenon in direct PCI group were higher than that in elective PCI group（ P 〈 0. 05 ）. There was no serious complication during procedures. During 24 months fillow-up, there was no death or recurrent AMI. Angina pectoris was observed in 7 patients 6 months after PCI,5 patients in direct PCI group and 2 patients in elective PCI group （ P 〈 0. 05 ）. Conclusion percutaneous coronary revascularization in AMI has a higher success rate and fewer serious complications. Compared with elective PCI, the emergent PCI may have a higher rate of slow-flow phenomenon and angina pectoris during follow-up.