序贯再通冠脉介入治疗对急性心肌梗死再灌注心律失常的影响

The effect of sequel recanalizational percutaneous coronary intervention on reperfusion arrhythmia in patients with acute myocardial infarction

目的探讨序贯再通冠脉介入治疗（sPCI）对急性ST段抬高性急性心肌梗死（STEMI）再灌注心律失常的影响。方法采用前瞻性研究方法对入选的176例STEMI患者随机分为序贯再通PCI治疗组（sPCI组，88例）和传统的直接PCI组（pPCI组，88例）。比较观察两组患者在介入治疗梗死相关动脉（IRA）开通后2h内再灌注心律失常的发生情况。结果两组MBG3级血流发生率比较差异有统计学意义（78．41％VS63．64％，x^2=4．67，P=0．03）。两组再灌注心律失常（RA）总的发生率比较差异无统计学意义（50．00％VS56．82％，x^2=1．12，P=0．36），但两组严重RA发生率比较差异有统计学意义（12．50％VS25．00％，x^2=4．51，P=0．03）。以sPCI为变量对严重RA的影响进行Logistic回归分析，OR值为0．43，95％C10．19～0．95，P=0．03。影响严重RA的其他因素：发病到IRA开始再通的时间（OR=0．61，95％CI 0．17—0．99，P=0．04），入院血糖水平（OR=1．96，95％CI1．02～5．78，P=0．03），梗死前心绞痛史（OR=0．65，95％CI 0．18～0．98，P=0．04）及心脏功能水平（OR=1．78，95％CI 1．06～6．91，P=0．04）。结论序贯再通PCI治疗在改善STEMI患者心肌血流灌注的同时，使严重再灌注心律失常减少，优于传统的直接PCI治疗。

Objective To explore the effect of sequel recanalization percutaneous coronary intervention （SPCI） on reperfusion arrhythmia （RA） during myocardial reperfusion for the patients with acute ST segment elevation myocardial infarction （STEMI）. Methods With a respective study method, 176 patients with STEMI were enrolled and divided randomly into two groups： sPCI group （88 cases） and conventional primary PCI （pPCI） group （88 cases）, to observe the rate of reperfusion arrhythmia of two groups, especially those of severe RA （SRA） within 2 hours after successful PCI process. Results There were significant differences between two groups in MBG3 （78.41% vs 63.64% , X2 = 4.67, P = 0.03 ）. There was no significant difference between two groups in the total rate of RA （50.00% vs 56. 82%, X2 =1.12, P = 0.36）, and there were significant differences between two groups in SRA （12.50% vs 25.00%, X^2 = 4.51, P = 0.03）. If sPCI was served as a variable for predicting SRA, the results of Logistic regression showed that odds ratio （OR） was 0.43,95% confidence interval （CI） was 0.19 - 0.95, P = 0.03. Other variables related to SRA included time - to - reeanalization （ OR 0.61, 95% CI 0.17 - 0.99, P = 0.04）, blood sugar level of admission （ OR 1.96, 95% CI 1.02 - 5.78, P = 0.03）, angina history （OR 0.65, 95% CI 0. 18 -0.98, P =0.04） and heart function （OR 1.78, 95%CI 1.06 -6.91, P = 0.04）. Conclusion The sequel recanalization PCI may be better than conventional PCI for the patients with STEMI in obtaining myocardial blush grades; meanwhile, it can reduce the rate of severe reperfusion arrhythmia.