超早期STEMI溶栓后即刻介入治疗主要临床终点事件评价

Evaluation on Major Clinical End-Point Events of Primary Coronary Intervention Immediately after Thrombolysis in Super-Early Stage of ST-Elevation Myocardial Infarction

目的探讨超早期(3 h内)ST段抬高型急性心肌梗死(STEMI)患者,急诊溶栓后即刻冠脉介入治疗与直接接受冠脉介入治疗(PCI)患者住院期间主要临床终点事件。方法超早期STEMI急诊溶栓并12 h内行PCI患者42例,同时,直接转院PCI 36例为对照组,比较两组住院期间心血管主要终点事件、左室功能、出血事件等差异。病例同时符合下列条件:溶栓后距行PCI术时间<12 h;发生心肌缺血时间(持续时间≥20 min),距溶栓时间<3 h;溶栓药物为尿激酶,且无溶栓禁忌者。结果两组患者治疗前在年龄、性别、吸烟史、血脂情况、糖尿病病史、高血压病史、左室功能及二级预防用药等一般情况的比较,差异无统计学意义(均P>0.05)。住院期间左室功能及主要心血管终点事件比较,急诊溶栓介入治疗组住院期间内病死率、心力衰竭或心源性休克发生率均低于直接PCI组(P<0.01),左室功能、出血情况和临床终点相似(P>0.05)。结论急诊溶栓后即刻转运PCI是安全有效的,并不增加住院期间心血管主要终点事件,不增加出血风险。

Objective To evaluate the major clinical end-point events of primary coronary intervention（PCI） immediately af- ter thrombolysis in super-early stage （ within 3 hours） of ST-elevation myocardial infarction （STEMI）. Methods The 42 patients with super-early stage of STEMI in the observation group underwent PCI in 12 hours as the thrombolysis ;36 patients in the control group underwent PCI without the thrombolysis. In the observation group ,the time between PCI and thrombolysis was less than 12 hours, duration of myocardial ischemia was more than 20 minutes, the time between the myocardial ischemia and thrombolysis was less than 3 hours, the drug for thrombolysis was urokinase, and the patients were without the contraindication of thrombolysis. The major cardiovascular end-point events, left ventricular function, bleeding, etc. were compared between the two groups. Results There was no difference in age, sex, history of smoking, blood lipid, history of diabetes and hypertension, left ventricular function and secondary prevention medications between the two groups （ P 〉 0.05 ）. The mortality, rate of heart failure and cardiogenic shock I the observation group was obviously lower than those of the control group（ P 〈 0.01 ）. There was no difference in left ven- tricular function, bleeding and left ventricular function（ P 〉 0.05 ）. Conclusion The primary coronary intervention immediately after thrombolysis for the patients with STEMI is safe and effective ;it doesn＇ t increase the major cardiovascular end-point events and risk of bleeding during hospitalization.