急性心肌梗死患者初期支架植入和rt-PA静脉溶栓加补救支架植入对比研究

Primary intracoronary stenting in comparison with intravenous rt-PA thrombolysis plus rescue intracoronary stenting in patients with acute myocardial infarction

目的 比较急性心肌梗死 (AMI)患者冠状动脉内初期支架植入和静脉rt PA溶栓加补救支架植入治疗的临床疗效。方法 98例首次AMI患者随机给以冠状动脉内初期支架植入 (初期支架组 :48例 )和静脉rt PA溶栓加补救支架植入 (溶栓加支架组 :5 0例 )。所有患者行急诊冠状动脉造影以TIMI血流分级法判断梗死相关冠状动脉 (IRA)开通情况。记录住院期心脏事件 ;出院前用二维超声心动图测定两组患者左心室舒张末期和收缩末期容量并推算左心室射血分数 (LVEF)。结果 急诊冠状动脉造影显示支架组 47例 (97 91% )溶栓加支架组 5 0例 (10 0 % )IRA血流TIMI 2 3级 ,但前者IRA前向血流TIMI 3级者明显增多 (分别为 93 8%和 6 0 0 % ,P =0 0 0 0 1)。两组患者住院期死亡率和心脏事件相似 ,但出院前超声心动图显示支架组LVEF(6 2 0 1%± 14 0 3% )高于溶栓加支架组(5 0 0 1%± 132 % ) ,P =0 0 0 0 1。结论 与静脉rt PA溶栓加补支架治疗相比 ,AMI初期支架植入可更好改善急性期心肌再灌注 。

Objective This study is sought to compare primary stenting in the infarct related coronary artery with intravenous rt PA therapy plus rescue intracoronary stenting with respect to clinical and angiographic outcomes of patients with an acute myocardial infarction (AMI) Methods Ninety eight patients with a first AMI were randomly treated with primary intracoronary stenting (primary stenting group) or with intravenous rt PA therapy plus rescue intracoronary stenting (thrombolysis plus stenting group) Thrombolysis in myocardial infarction (TIMI) flow grade was assessed by angiography in emergency, and cardiac function (left ventricular ejection fraction, LVEF) was calculated by echocardiography before discharge between the two groups Results There were 47 patients (97 91%) in primary stenting group and 50 patients (100%) in thrombolysis plus stenting group had achieved TIMI grade 2 3 flow after the procedure But the former had more cases (93 8%) had TIMI 3 flow than that of latter (60 0%), P =0 0001 There was no difference between the two groups in cardiac events during hospitalizaton But the patients in primary stenting group had better cardiac function (LVEF 0 62±0 14 vs 0 50±0 12, P =0 0001) Conclusion Primary intracoronary stenting may improve myocardial reperfusion in emergency and inhibit the decline of cardiac function after AMI in comparison with intravenous rt PA thrombolysis plus rescue intracoronary stenting