延迟PCI对急性ST段抬高型心肌梗死预后的影响

The Long-Term Effect of Delayed PCI on ST-Segment Elevation Acute Myocardial Infarction

目的探讨延迟PCI对急性ST段抬高型心肌梗死（STEMI）预后的影响.方法 563例STEMI患者分为直接PCI组157例、延迟PCI组124例、溶栓组131例和药物组151例.随访4~88个月,平均随访（45±27）个月;观察主要心脏不良事件（MACE）、超声心动图指标变化及QRS计分评估梗死范围的变化.结果延迟PCI组MACE发生率显著少于溶栓组和药物治疗组（P〈0.05）,与直接PCI组比较无统计学意义（P〉0.05）;延迟PCI组的LVEF显著高于非PCI治疗组（P〈0.05）,而延迟PCI组的LAD和LVDd均显著小于非PCI组;延迟PCI组的心肌梗死范围回缩率显著大于药物治疗组（P〈0.05）.结论延迟PCI可减少MACE发生率,并改善左室功能,使心肌梗死面积缩小,改善STEMI患者的预后.

Objective To evaluate the long-term effects of delayed PCI on ST-segment elevation acute myocardial infarction（STEMI）.MethodAmong 563 patients with STEMI,157 patients were treated by immediate PCI（immediate PCI group）;124 patients were treated by delayed PCI（delayed PCI group）;131 patients were treated by the intravenous thrombolytic therapy（thrombolytic group） and 151 patients were treated by medical therapy（medical group）.All patients were followed up during 4~88 months with mean（45±27） months about major adverse cardiac events（MACE） and the cardiac structure and function by echocardiography and infarct size estimated by the QRS point system.ResultsThe incidence of MACE in delayed PCI group was significantly less than those of thrombolytic group and medical therapy group（P0.05）;but there was similar to that in immediate PCI group.LVEF in delayed PCI group was significantly higher than those in thrombolytic group and medical therapy group（P0.05）;LVDd and LAD in delayed PCI group was significantly less than those in thrombolytic and medical therapy group.The retraction of MI size in delayed PCI was greater than that of medical group and were similar to immediate PCI group.ConclusionDelayed PCI may decrease incidence of MACE and infarct size,improve left ventricular function and prognosis of patients.