直接经皮腔内冠状动脉成形术及支架治疗对急性心肌梗死患者左心室重构和左心功能的影响——与尿激酶溶栓治疗对照

Effect of primary percutaneous transluminal coronary angioplasty and stent implantation on left ventricular remodeling and function in patients with acute myocardial infarction:compared with thrombolytic therapy

目的 观察和评价直接经皮腔内冠状动脉成形术 (PTCA)及支架治疗对急性心肌梗死患者左心室重构和左心功能的影响。方法 对初次发病、发病 12小时以内或 12～ 2 4小时之间仍有心肌缺血证据、且无溶栓禁忌症的患者 ,随机给予直接PTCA和尿激酶 (15 0万IU)溶栓治疗 ,于 2周、12周和 2 4周行二维超声心动图检查并记录有关心脏事件。结果 共入选 6 5例患者 ,男性 5 5例 ,女性 10例 ,平均年龄 5 8 95± 8 94岁。其中PTCA组 32例 ,血管再通率为 10 0 % ;溶栓组 33例 ,血管再通率为 75 76 %。 2周后PTCA组的左心室收缩末容积指数 (ESVI)、左心室舒张末容积指数 (EDVI)、左心室射血分数 (LVEF)和梗死区室壁运动指数 (RWMI)均显著优于溶栓组 (P <0 0 5 ,P <0 0 5 ,P <0 0 1,P<0 0 5 )。溶栓组 12周和 2 4周ESVI(P <0 0 1,P <0 0 1)、EDVI(P <0 0 5 ,P <0 0 1)、LVEF(P <0 0 5 ,P<0 0 1)、GWMI(P <0 0 1,P <0 0 1)以及RWMI(P <0 0 5 ,P <0 0 1)与 2周时比显著改善 ;PTCA组ESVI(P <0 0 1,P <0 0 1)、EDVI(P <0 0 1,P <0 0 1)、LVEF(P >0 0 5 ,P <0 0 5 )、GWMI(P <0 0 5 ,P <0 0 1)以及RWMI(P <0 0 5 ,P <0 0 5 )也有显著改善。至 2 4周时 ,PTCA组和溶栓组EDVI(P >0 0 5 )、LVEF(P >0

Objective To observe prospectively the changes of left ventricular size and function, and to evaluate the impact of primary percutaneous transluminal coronary angioplasty (p-PTCA) and stent implantation and thrombolytic therapy on left ventricular remodeling and function. Methods The patients with a first acute myocardial infarct and without contraindications to thrombolytic therapy were randomly assingned to p-PTCA group or urokinase (1?500?000 IU) therapy group within 12 hrs from the onset of symptoms or within 12～24 hrs if the evidence of myocardial ischemia in infarc zones was available. Two-demensional echocardaography were applied in the 2 nd , 12 th , and 24 th week after infarction, and major cardiac events were recorded. Results Sixty-five patients were enrolled (male 55, female 10, age 58.95±8.94 y). The patency of infarct related artery of 32 patients assigned to p-PTCA was 100%, while that of thrombolytic therapy group (33 patients) was 75.76%. The differences of end-systolic volume index (ESVI), end-diastolic volume index (EDVI), left ventricular ejection fraction (LVEF), and regional wall motion score index (RWMI) were significant statistically between p-PTCA group and thrombolytic therapy group ( P <0.05, P <0.05, P <0.01, P <0.05, respectively) in 2 nd week after infarction. The trend was true of that of the 12 th week after infarction. Between p-PTCA group and thrombolytic therapy group in the 24 th week after infarction, there was no significant difference in EDVI, LVEF, and RWMI, except ESVIference in global wall motion score index (GWMI) during the whole observation period. Conclusion Compared with urokinase therapy, p-PTCA would have better effect on preventing left ventricular remodeling and improving left ventricular function. The latter might reduce the necessity for revascularization also.