静脉溶栓及急诊PCI术治疗75岁以上老年急性心肌梗死患者的临床对比分析

Comparison of the clinical efficacy of direct percutaneous coronary intervention with thrombolytic therapy for acute myocardial infarction in patients more than 75 years

目的探讨静脉溶栓及急诊经皮冠状动脉介入治疗(PCI)术治疗75岁以上老年急性心肌梗死患者的临床疗效。方法将171例75岁以上确诊为急性心肌梗死的老年患者分为静脉溶栓组(溶栓组)85例、急诊PCI组(介入组)86例,分别接受静脉溶栓及急诊PCI术治疗,并进行随访,比较两组梗死相关血管(IRA)再通率及治疗后0、1、3个月左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、主要心脏不良事件(MACE,包括再梗死、再发心绞痛、严重心力衰竭、死亡等)发生率的差异。结果随访结束溶栓组因重度肺炎死亡1例,介入组失访1例,共有169例患者完成随访。IRA再通率介入组显著高于溶栓组(90.70%vs.58.82%,P<0.05),两组相比差异有统计学意义。治疗前后,左心室功能指标,溶栓组及介入组LVEF为(53.1±8.7)%vs.(63.2±7.4)%,LVEDD为(54.2±9.4)mm vs.(46.6±9.5)mm;介入组优于溶栓组,差别有统计学意义(P<0.05)。两组MACE发生率(33.3%vs.17.6%),介入组显著低于溶栓组(P<0.05),差异有统计学意义。结论针对75岁以上老年急性心肌梗死患者,急诊PCI术较静脉溶栓治疗能更有效地开通梗死相关动脉,及时灌注缺血心肌,改善左心室功能,降低心血管事件再发率。

Objective To contrast the clinical efficacy of direct percutaneous coronary intervention（PCI）with thrombolytic therapy in acute myocardial infarction（AMI） patients more than 75 years.Methods One hundred and sixty-nine AMI patients more than 75 years were divided into direct PCI treatment group（n=85） and thrombolytic therapy group（n=84）.The infarct-related artery（IRA） reperfusion rate,left ventricular ejection fraction（LVEF）,left ventricular end-diastolic diameter（LVEDD） and the rate of major adverse cardiac events（MACE） including myocardial reinfarction,recurrent angina,congestive heart failure and cardiac death were compared.Results One patient was dead because of severe pneumonia in thrombolytic therapy group and another one in direct PCI treatment group was lost after 3 months follow-up.The IRA reperfusion rate was 90.70% in direct PCI treatment group and 58.82% in thrombolytic therapy group（P0.05）.There were also significant differences in LVEF,LVEDD and the MACE rate in three months after AMI between both groups.Conclusion Direct PCI in patients more than 75 years could reperfuse IRA efficaciously,rescue dying myocardium rapidly,improve left ventricular function and reduce rate of major adverse cardiac events.