不同方法冠状动脉介入治疗对ST段抬高心肌梗死患者疗效的影响

Effects of different direct coronary intervention procedures on ST-segment elevation myocardial infarction

目的 探讨不同方法经皮冠状动脉（冠脉）介入治疗（PCI）对ST段抬高心肌梗死（STEMI）远期疗效的影响. 方法 选取2009年1月至2012年12月期间在我院住院的行急诊行PCI的STEMI患者65例,按治疗方法分为对照组29例和观察组36例,对照组直接行梗死相关动脉PCI治疗,观察组为冠脉内注射替罗非班联合血栓抽吸后,行梗死相关动脉PCI治疗,比较两组心肌再灌注临床指标、并发症发生率和随访1年心血管事件发生率. 结果 治疗后观察组与对照组比较,无复流/慢血流现象发生率低（11.1％比24.1％,P＜0.01）,病变血管心肌梗死溶栓试验（TIMI）血流分级高（2.9±0.2比2.1±0.3,P＜0.05）,术后2h心电图ST段回落比例高（80.5％比62.1％,P＜0.01）.术后10d,观察组脑钠肽水平低于对照组（P＜0.05）,观察组LVEF高于对照组（P＜0.05）.术后1年,观察组LVEF亦明显高于对照组,分别为（55.1±1 3.2）％比（49.0±11.5）％（P＜0.05）;随访1年主要心血管不良事件（包括心绞痛、心肌梗死、心力衰竭、心因性死亡）发生率两组差异无统计意义（P＞0.05）. 结论 冠脉内注射替罗非班联合血栓抽吸导管抽吸及支架置入,能促进STEMI患者急诊PCI术后的ST段回落,可以最大程度缩小心肌坏死的范围,提高再灌注水平,改善心肌重塑,从而改善心肌功能.

Objective To examine the long-term effects of two different percutaneous coronary intervention （PCI） procedures on ST segment elevation myocardial infarction （STEMI）.Methods A total of 65 patients with STEMI undergoing emergency PCI from January 2009 to December 2012 at our hospital were enrolled in the study.Patients were divided into Group A,which received direct PCI in the infarct related artery （IRA） （n =29）,and Group B,which received PCI after intracoronary tirofiban administration and thrombus aspiration （n =36）.Clinical indicators of myocardial reperfusion,complication rates and cardiovascular events for both groups were followed up for one year and compared.Results Compared with Group B,the no reflow/slow flow rate decreased （11.1% vs.24.1%,P〈0.01）,TIMI grade flow increased [（2.9 ±0.2） vs.（2.1 ±0.3）,P〈 0.05] and the proportion of ECG ST-segment resolution 2h after PCI increased in Group A （80.5% vs.62.1%,P〈0.01）.Natriuretic peptide levels were lower in Group B than in Group A 10 days after PCI.Left ventricular ejection fractions （LVEF） 10 days and one year after PCI were both higher in Group B than in Group A respectively （P〈0.05）.There were no statistical differences in the incidences of major adverse cardiovascular events including angina,myocardial infarction,heart failure and cardiac death between the two groups （P〉0.05 for all）.Conclusions For STEMI patients who receive emergency PCI,the classical coronary intervention combined with intracoronary tirofiban administration and thrombus aspiration can promote ST-segment resolution,narrow the scope of myocardial necrosis,and improve the level of reperfusion and myocardial remodeling,thus boosting cardiac function.