梗死相关血管延迟血运重建对急性心肌梗死的临床疗效

The clinical effects on acute myocardial infarction treated by delayed revascularization

目的 探讨梗死相关血管延迟血运重建对急性心肌梗死的临床疗效.方法 将275例急性心肌梗死患者分为延迟血运重建治疗组（124例）和药物治疗组（151例）.对所有患者随访4～88个月,观察住院期间和随访期间的临床不良事件和超声心动图的变化及利用QRS计分评估梗死范围的变化.结果 延迟血运重建组平均住院时间[（13.8±9.7）日]显著少于药物治疗组[（19.8±8.9）日]（P〈0.05）;延迟血运重建组的复合终点事件发生率显著少于药物治疗组（P〈0.05）;随访期间,延迟血运重建组的心力衰竭及复合终点事件的发生率显著低于药物治疗组（P〈0.05）.超声心动图随访结果示延迟血运重建组的左室射血分数显著高于药物治疗组（P〈0.05）,延迟血运重建组的左室舒张末期内径显著小于药物治疗组（P〈0.05）.延迟血运重建组的心肌梗死范围回缩率（0.376±0.129）显著大于药物治疗组（0.173±0.098）（P〈0.05）.结论 延迟血运重建能减少住院和随访期间心脏事件发生率、改善左心室功能、使心肌梗死面积缩小,改善急性心肌梗死病人的预后.

Objective To evaluate the clinical effects on acute myocardial infarction（AMI） treated by delayed revascularization. Methods Among 275 patients with AMI 124 patients were treated by delayed revascularization（ delayed revascularization group） and 151 patients were treated by medical therapy（ medical therapy group）. All patients were investigated during in-hospital and follow-up（ mean of follow-up 45 ±27 months） regarding major adverse cardiac events （MACE） and the cardiac structure and function by echocardiography and infarct size estimated by QRS point system. Results Average hospital stays（meanl3.8 ±9.9d） in delayed revascularization group were significantly shorter than those（ mean 19.8 ±8.9 d） of medical therapy group （ P 〈 0.05 ）, the incidence of MACE and heart failure in delayed revascularization group were significantly less than those of medical therapy group（P 〈 0.05 ）in follow-up period. The recurrence myocardial infarction （3.7） and cardiac deaths （4.6%） in delayed revascularization group was lower than those（ 14.9% and 18.4% ） in medical therapy group. LVEF（55.8% ） in delayed revascularization group was significantly larger than those（46.6% ） of medical therapy group（ P 〈 0.05）. The rate of retraction in QRS score-estimated MI size by initial vs follow-up electrocardiograms （0.376± 0. 129） in delayed revascularization group was greater then that （0. 173±0. 098 ） of medical therapy group. Conclusions Delayed revascularization may shorten in-hospital stay, decrease the incidence of MACE and infarct size during follow-up, and improve left ventricular function and prognosis.