急诊经皮冠状动脉球囊扩张成形术延期支架植入对急性ST段抬高心肌梗死患者预后的影响

Clinical outcomes of primary stenting versus delayed stenting in patients with acute ST elevation myocardial infarction after successful percutaneous transtuminal coronary angioplasty

目的行急诊经皮冠状动脉球囊扩张成形术(PTCA)使心肌梗死溶栓试验(TIMI)血流达3级后,比较延期支架植入与即刻支架植入两种治疗方式对预后的影响。方法 58例急性ST段抬高的心肌梗死患者经急诊PTCA使TIMI血流达3级后,随机分为延期支架组和即时支架组,每组29例。延期支架组先结束介入治疗,强化抗血小板治疗,1周后再接受支架植入术。即时支架组于PTCA后植入支架。观察随访至30d时的心血管事件(包括致命性或非致命性心肌梗死、血运重建、心源性死亡、各种原因的死亡、支架植入时无复流或慢血流及支架血栓)。结果延期支架组的心血管事件发生率为6.9%(2/29),显著低于即时支架组的27.6%(8/29,P=0.079)。延期支架组无1例发生无复流现象,而即时支架组无复流现象的发生率为24.1%(7/29,P=0.01)。结论治疗冠状动脉急性血栓病变,在行PTCA使TIMI血流达3级后,先予强化抗血小板治疗支持,再延期植入支架,可取得与即刻支架植入等同的效果,更有利于减少无复流现象的发生。

Objective To compare the outcomes of primary stenting and delayed stenting in patients with acute ST elevation myocardial infarction（STEMI） after successful percutaneous transluminal coronary angioplasty （PTCA）.Methods From May 2004 to October 2006,58 consecutive STEMI patients underwent primary PTCA within 12 hours after onset of chest pain;patients with high thrombus burden,TIMI 3 grade flow and mild coronary dissection were randomly assigned to receive primary stenting（n = 29） or delayed stenting（1 weeks after PTCA, n = 29）.All patients received guideline medical therapy and were followed up for 30 days.Myocardial infarction, target lesion revascularization,death of cardiac cause and of all causes,stent thrombosis and angiographic noreflow post stenting procedure were observed.Results The baseline characteristic parameters were similar between the two groups.There were no significant difference in the cardiovascular events between the two groups （6.9%vs.27.6%,P =0.079）.The incidence of post-stenting no-reflow was significantly higher in the primary stenting group（no no-reflow） than that in delayed stenting group（24.1%,P = 0.01）.Conclusion Delayed stenting in patients with high thrombus burden and mild coronary dissection after successful PTCA is associated with lower no-reflow incidence compared with primary stenting.