急性心肌梗死“罪犯血管”自发再通的介入治疗108例临床观察

Percutaneous coronary intervention in patients with acute myocardial infarction and spontaneous acute patency of the culprit artery

目的:评价急性ST段抬高心肌梗死患者"罪犯血管"自发再通后早期介入策略与择期介入策略的远期疗效。方法:108例急性ST段抬高心肌梗死伴自发再通患者随机分为2组,每组各54例。早期介入组立即按常规行直接经皮冠状动脉介入;择期介入组药物治疗7d后行择期经皮冠状动脉介入。随访1年,主要研究终点死亡、非致死性心肌梗死、靶病变再次血运重建;次要研究终点包括无复流或慢血流、心肌缺血复发和左心室射血分数。结果:随访1年,与早期介入组比较,择期介入策略组死亡(1.9%vs.1.9%,P=0.736);心肌梗死(5.6%vs.1.9%,P=0.763);靶病变再次血运重建(4.6%vs.5.6%,P=0.879);无复流或慢血流(2.3%vs.18.5%,P=0.029);左心室射血分数[(60±10)vs.(55±12)%,P=0.005];心肌缺血复发(29.6%vs.11.1%,P=0.031)。结论:急性ST段抬高心肌梗死自发再通血流恢复,心肌梗死溶栓分级(TIMI 3)级的患者采取择期介入策略,可以改善心肌灌注、提高患者远期左心室收缩功能。

Objective：This study was designed to evaluate long-term efficacy of elective PCI versus early invasive strategies in patients with ST elevation myocardial infarction（STEMI） and spontaneous acute patency of the culprit artery.Methods：One hundred and eight patients with STEMI and spontaneous reperfusion were assigned in two groups randomly.In the early invasive strategy group,patients underwent primary percutaneous coronary Intervention（PPCI）,and in the elective PCI strategy（EPCI） group,PCI was performed 7 days after the onset of STEMI.The 1 year outcomes were analyzed.The main endpoints included death,non-fatal acute myocardial infarction,target lesion revascularization（TLR）.The secondary endpoints included no-reflow or slow-flow,recurrent ischemia and left ventricular ejection fraction（LVEF）.Results：After 1 year follow-up,no differences were observed in death（1.9% vs.1.9%,P=0.736）,myocardial infarction（5.6% vs.1.9%,P=0.763） and TLR（4.6% vs.5.6%,P=0.879） between the EPCI group and the PPCI group.Compared with the PPCI group,patients in the EPCI group developed no-reflow or slow-flow less frequently（2.3% vs.18.5%,P=0.029）,had higher LVEF[（60±10） vs.（55±12）%,P=0.005]and a higher incidence of recurrent ischemia（29.6% vs.11.1%,P=0.031）.Conclusion：The EPCI strategy had better myocardial perfusion and long-term LVEF over early invasive strategy in patients with STEMI and spontaneous reperfusion.