直接PTCA与静脉溶栓治疗AMI近期疗效观察

A COMPARISON OF THE CLINICAL EFFICACY OF PRIMARY ANGIOPLASTY WITH THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL INFARCTION DURING HOSPITALIZATION

目的 :比较直接经皮冠状动脉腔内成形术 (PTCA)与尿激酶静脉溶栓治疗急性心肌梗塞 (AMI)患者住院期间的临床疗效。方法 :随机地将首次AMI患者分为直接PTCA组 (2 6例 )和尿激酶静脉溶栓组 (49例 ) ,观察冠脉再通率、住院病死率和再发心梗率以及出院前左室射血分数 (LVEF)。结果 :溶栓组梗塞相关动脉 (IRA)再通率为 6 9.39% ,直接PTCA组IRA成功再通率为 92 .31% ,差异有显著性 (P <0 .0 5 )。住院期间病死率和再发心梗率溶栓组均有增加的趋势 ,但差异无显著性 (P >0 .0 5 )。出院前左室射血分数溶栓组为 4 5 .91± 9.6 6 ,直接PTCA组为 5 3.4 8± 7.4 7,差异有显著性 (P <0 .0 5 )。溶栓组因再闭塞或缺血发作行择期PTCA的比率明显高于直接PTCA组 (2 0 .4 1%vs 0 % ,p <0 .0 5 )。两组IRA开通组行选择性冠状动脉造影 (CAG)示IRA前向血流达TIMI - 3级 ,溶栓组为 2 5 % ,直接PTCA组为 10 0 % ,两组间有极显著性差异 (P <0 .0 0 5 )。结论 :AMI患者行直接PTCA较溶栓治疗更能充分有效地开通梗塞相关动脉 (IRA) ,更能挽救阻塞血管区域的心肌 ,从而更好地改善患者心功能 。

Objective:To compare the clinical efficacy of primary angioplasty with thrombolytic therapy in the treatment of acute myocardial infarction(AMI) during hospitalization. Methods :The patients with a first AMI were randomly assigned to urdergo either primary angioplasty (26 patients) or intravenous thrombolytic therapy(49 patients). The recanalizing rates of infarct-related arteries(IRA), the in-hospital mortality rates and the rates of reinfarction were observed. Cardiac function (left ventricular ejection fraction, LVEF) was assessed during hospitalization by echocardiography. Results:The recanalizing rate of IRA in patients with thrombolytic therapy was 69.39%, while in those with primary angioplasty was 92.31%. The in-hospital mortality rate and the reinfarction rate in the thrombolysis group have an increasing tendency(P>0.05). There were no significant differences in age, risk factors, time from onset of symptom to treatment and infarct location between the two groups but apparent difference was found in LVEF(45.91±9.66 vs 53.48±7.47, P<0.05).In additon, the rates of performing elective PTCA for reclusion or recurrent ischemia were 20.41% and 0%, respectively(P<0.05). The rate of IRA restoring to TIMI-3 grade blood flow in the primary PTCA group was higher than that of the thrombolysis group. Conclusion:It is clear from our outcomes that primary PTCA results in wider patency of the infarct-related coronary arteries than does thrombolysis. Primary PTCA is more effective than thrombolytic therapy in saving ischemia field myocardium, improving cardiac function after AMI and reducing mortality and reinfarction rates.