易化PCI对比直接PCI治疗ST段抬高性心肌梗死的有效性及安全性分析

Comparison of efficacy and safety between facilitated PCI and primary PCI on ST-segment elevation myocardial infarction

目的比较易化PCI和直接PCI治疗ST段抬高性心肌梗死的近期疗效及安全性。为寻找适合我国国情的治疗ST段抬高性心肌梗死(STEMI)的方法提供一定的临床依据。方法 ST段抬高型心肌梗死患者48例,根据患者意愿分别行易化PCI(22例)和直接PCI(26例)。易化PCI组给予小剂量溶栓后再行PCI;直接PCI组则直接行PCI手术。比较PCI治疗后冠状动脉开通率、PCI术后1 h常规心电图上ST段回落率、住院期间不良心脏事件发生率(包括休克、中风、再梗塞、缺血复发、充血性心衰、大出血、死亡),出院前左室射血分数(LVEF)。结果易化组在ST段完全回落组(≥70%)的比例显著高于直接组(36.4%vs11.5%),差异具有统计学意义(P<0.05)。而在ST段部分回落组(30%～70%)与小于30%的ST段回落率中,前后两组差异不具有统计学意义(P>0.05)。易化组与直接组在IRA介入术后TIMIⅡ、Ⅲ血流的比例上无统计学差异(P>0.05)。易化组与直接组在IRA再梗死(包括缺血复发)、休克、中风、充血性心力衰竭、出血并发症、住院期间死亡率及出院前左室射血分数等方面均无统计学差异(P值均大于0.05)。结论与直接PCI相比,易化PCI具有较高比例的ST段完全回落率,而出血事件和MACE未明显增加,相对安全。易化PCI与直接PCI一样可使缺血心肌获得快速有效的再灌注,且安全易行,并未明显增加患者的出血事件,值得进一步研究探索及推广应用,尤其是在距离有完善导管室设备的城市、较远的农村及边远地区。

Aim To compare the short-term efficacy and safety between facilitated PCI and primary PCI on ST-segment elevation myocardial infarction（STEMI） for finding a better method of acute myocardial infarction（AMI） in China.Methods 48 cases were selected and assigned to facilitated PCI group（22 cases） and primary PCI group（26 cases）.All of the patients had given informed consent before assigned.Facilitated PCI group was given low-dose thrombolytic therapy before making PCI and primary PCI group was carried out PCI procedure as soon as possible.Comparison of every clinical index after treatment between facilitated PCI group and primary PCI group was made.These indexes included the rate of recanalization of infarct-related artery（IRA）,ST segment resolution,left ventricular ejection（LVEF）,and major adverse cardiac events（MACE,such as shock,stroke,reinfarction,recurrent ischemia,congestive heart failure,bleeding and death）.Results ST segment completely resolution group（≥70%） in facilitated group was significantly higher than the proportion of the primary group（36.4%vs 11.5%）,statistically significant difference（P0.05）.In the lower part of the ST-group（30%～70%） and less than 30% of the ST segment resolution,the difference was not statistically significant（P0.05）.Facilitated group of IRA after PCI TIMI Ⅱ,Ⅲ was not statistically different in the proportion of blood flow（P0.05）.As to IRA reinfarction（including recurrent ischemia）,shock,stroke,congestive heart failure,bleeding complications,postoperative mortality during hospitalization and LVEF（50%） in facilitated group and the primary group,although there were differences,all showed no statistical significance（P0.05）.Conclusions Compared with the primary PCI,facilitated PCI could achieve higher proportion of ST segment resolution.Without increasing MACE and major hemorrhage bleeding,facilitated PCI is effective and safe for the patients with STEMI in China,especially in the areas away from city.