急性心肌梗死延迟PCI对左心室重构和功能的影响

Effects of Delayed PCI on Left Ventricular Remodeling and Function in Acute Myocardial Infarction

目的:探讨延迟经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者左心室重构和左心功能的影响。方法:将95例初次急性ST段抬高心肌梗死患者分为两组:PCI组(n=45)和对照组(n=50)。PCI组于发病后平均10 d对梗死相关动脉及其他严重狭窄的血管行PCI,对照组单纯药物治疗。两组患者于发病后1、12、24周行二维超声心动图检查,并随防半年内心脏事件的发生。结果:24周随访,PCI组左心室心肌重量(LVMWg)、左室舒张末容积(EDV)、左室收缩末容积(ESV)、左室射血分数(EF)及室壁运动指数(WMSI)均显著优于对照组(P<0.01)。PCI组患者12、24周LVMWg、EDV、ESV、EF、WMSI与1周相比显著改善。PCI组患者半年后在心力衰竭和复合终点事件方面较对照组明显下降(P<0.01)。结论:AMI后延迟PCI可抑制左心室重构,改善左心功能,并显著减少心脏事件的发生。

Objective：To investigate the effects of delayed percutaneous coronary intervention（PCI） on left ventricular remodeling and function in patients with acute myocardial infarction.Methods： 95 patients with a first acute ST-segment elevation myocardial infarction were randomly divided into the PCI group（n=45）and control group（n=50）.Delayed PCI on infarct-related artery and those severe stenosis arteries was performed approximately 10 days of onset on patients in the PCI group.The drug therapy only was given other patients in the control group.Patients all accepted two-dimensional echocardiography in 1st、 12th and 24th week after infarction,and followed up occurrence of major cardiac events within half a year.Result： In the 24th week after infarction,compared with the control group,the Left ventricular myocardium weight（LVMWg）,end-diastolic volume（EDV）,end-systolic volume（ESV）,left ventricular ejection fraction（LVEF）,and regional wall motion score index（WMSI） were significantly improved in the PCI group（P〈0.01）.In the PCI group,the LVMWg、EDV、ESV、EF、 WMSI were significantly better in the 12th and 24th week compared with those in the 1st week after onset.Half a year later,compared with the control group, heart failure and composite events（P〈0.01） were significantly decreased in the PCI group.Conclusion： Delayed PCI could Prevent left ventricularremodeling and improve Left ventricular function,so as to desease significantly occurrence of cardiac events.