易化PCI与直接PCI治疗ST段抬高型心肌梗死的比较研究

A comparative study of primary and facilitated percutaneous coronary intervention for acute myocardial infarction

目的比较易化PCI与直接PCI治疗ST段抬高型心肌梗死的疗效和安全性。方法ST段抬高型心肌梗死患者204例,在发病12 h内,分为易化PCI组(83例)与直接PCI组(121例)。易化PCI组先静脉应用肝素和重组组织型纤溶酶原激活剂(rt-PA)50 mg,然后尽快行PCI治疗。直接PCI组单纯行PCI治疗。观察介入术前梗死相关动脉(IRA)TIMI血流分级、IRA术前开通率、IRA术后TIMIШ级率、IRA术后开通率、术后LVEF值、主要心脏不良事件(MACE)及出血并发症,并依据开始介入治疗时间对两组分别进行亚组分析。结果易化PCI组介入术前IRA开通率、TIMIШ级血流率、术后LVEF值均明显高于直接PCI组,IRA术后TIMIШ级率、开通率、MACE和出血并发症两组间无明显差异。直接PCI与易化PCI治疗都有时间依赖性,3 h内开始介入治疗再灌注效果最好。结论与直接PCI相比,易化PCI使缺血心肌获得迅速和充分的再灌注,术后心功能改善,而出血事件和MACE未明显增加,相对安全。

Objective To compare primary and facilitated percutaneous coronary intervention （PCI）for therapy of acute myocardial infarction and to evaluate the efficacy and safety of facilitated PCI. Methods Two hundred and four patients with ST-segment elevation myocardial infarction （STEMI） were divided into facilitated PCI group（ n = 83 ） and primary PCI group（ n = 121 ）. The patients in facilitated PCI group firstly received 50 mg rt-PA in 30 min after giving heparin, then treated with PCI immediately. The patients in primary PCI group were treated only with PCI but without thrombolysis. Thrombolysis in myocardial infarction （TIMI） grade, the rate of recanalization of infart-related artery （IRA） before and after PCI, left ventricular ejection（LVEF） after PCI, and major adverse cardiac events （MACE）, major hemorrhage in hospital in the two groups were compared. In each group, clinical data were analyzed by dividing subgroups according to symptom-to-ballon time. Results The rate of recanalization, TIMI grade of IRA before PCI and left ventricular ejection in facilitated PCI group were higher titan those in primary PCI group. There was no significant difference between the MACE and major hemorrhage of the two groups. In patients with STEMI treated with a facilitated PCI strategy using half dose rt-PA, myocardial reperfusion, cardiac function, the rate of TIMI grade were impoved without increasing MACE and major hemorrhage compared with primary PCI. Conclusion Facilitated PCI is an effective and safe treatment for acute myocardial infarction.