不同IRA开通时间对AMI急诊PCI后中远期预后关系的临床研究

Effect of open Time of Infarction Related Artery in Emergency PCI on Long-term Prognosis

目的探讨不同梗死相关动脉(IRA)开通时间对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入(PCI)治疗后中远期预后的影响。方法 50例初发急性心肌梗死行急诊经皮冠状动脉介入治疗患者,按冠状动脉梗死相关血管开通时间分A组(6h之内)27例和B组(6h～12h)23例。对比分析两组的临床资料、梗死相关血管情况、冠脉病变范围及支架植入情况,并随访梗死后3年主要心脏事件的发生率。分析急性心肌梗死患者有效再灌注治疗后中远期预后的影响因素。结果①年龄、性别、吸烟、饮酒、入院至IRA开通时间、抗凝用药、溶栓治疗、梗死前24h心绞痛、高血压、糖尿病、高脂血症、PCI前室性心律失常、PCI前心肌肌钙蛋白T(cTnT)升高及出院时左室射血分数(LVEF)两组比较无统计学意义(P>0.05)。②两组梗死相关血管发生率、冠脉病变范围比较无统计学意义,两组均采用雷帕酶素药物涂层支架,植入支架的直径和长度无统计学意义,支架植入后取得满意的血管再灌注。③本研究中不同IRA开通时间组间除B组有1例患者再次血运重建外,两组在随访期内均无其他主要心脏事件发生。结论及时有效的血管再灌注治疗极大地降低了AMI患者主要心脏事件的发生率,明显改善其中远期预后。

Objective To investigate the effect of open time of infarction related artery（IRA）on the long-term prognosis in acute myocardial infarction（AMI）with emergency percutaneous coronary intervention（PCI）.Methods Fifty patients（pts）with initial AMI by emergency PCI were divided into two groups according to open time of IRA：A group（〈6 h,n=27）and B group（6 h to 12 h,n=23）.The clinical and lesion characteristics and stent results were compared between two groups.The major adverse cardiovascular events（MACE）were followed up for 3 years after AMI.The prognosis factors for long-term clinical prognosis in pts with AMI were analyzed.Results ①There was no significant difference between two groups in clinical characteristics（P〉0.05）.②There was no significant difference between two groups in lesion characteristics（P〉0.05）.There was no significant difference between two groups in stent results（P〉0.05）.③There was no MACE in two groups during following up but one patient who suffered coronary artery bypass grafting in B group（P〉0.05）.Conclusion PCI could reduce MACE in pts with AMI,and improve long-term prognosis obviously.