重组组织型纤溶酶原激活剂加补救性冠状动脉介入术与直接冠状动脉介入术对急性心肌梗死的疗效研究

Recombinant tissue plasminogen activator plus rescue coronary interventional procedures and primary coronary interventional procedures in the effective study of acute myocardial infarction

目的 为比较急性心肌梗死 (AMI)患者应用重组组织型纤溶酶原激活剂 (rt PA) 5 0mg治疗 ,加补救性经皮冠状动脉腔内成形术 (PTCA)或冠状动脉内支架 (Stent)置入术与直接PTCA/Stent置入术临床疗效。方法 135例首次AMI患者随机给予以静脉rt PA溶栓加补救性PTCA/Stent(A组 )和直接PTCA/Stent(B组 )。 6 8例患者用阿司匹林和肝素后 ,接受rt PA5 0mg治疗 ,6 7例直接PTCA和支架。行急诊冠状动脉造影 (CAG) ,以TIMI血流分级法评估 ,必要时做PTCA/Stent。本研究终点包括分析两组患者的梗死相关血管 (IRA)开通率 ,并发症发生率、病死率及左心室功能。结果 A组IRA开通率为 91 0 % ,B组IRA开通率 95 5 %。患者于首次PTCA前及在 3周后用超声心电图测定两组患者左心室射血分数 (LVEF)。两组患者到达导管室时IRA血流已达TIMI3级者 (n =34其中A组 2 4例 ,B组 10例 ) ,最初和恢复期EF值分别为 6 0 8%和 6 2 5 % ,经介入治疗后变为TIMI 3级 (n =80 )者 ,其中A组 75 % (33/ 4 4 ) ,B组为 84 2 % (47/ 5 7) ,最初EF 5 7 0 %和恢复期EF5 7 2 %。从未获TIMI 3级 (n =2 1)者 ,其最初EF 5 4 1%和恢复期EF5 3 2 %为最低。结论 溶栓剂rt PA 5 0mg治疗加补救性PTCA/Stent与直接PTCA/Stent,在AMI中的疗效比较 。

Objective The aim of this study was to compare the effects of primary percutaneous transluminal coronary angioplasty (PTCA)/Stent and thrombolytic agent rt PA 50mg plus rescue PTCA/Stent on the patients with acute myocardial infarction (AMI) Methods 135 patients with first AMI were randomly treated with intravenous rt PA 50mg therapy plus rescue PTCA/Stent (group A ) or with primary PTCA/Stent (group B) 68 of 135 patients received rt PA 50mg after aspirin and heparin Primary PTCA/Stent was in the other 67 patients TIMI flow grade of thrombolysis in myocardial infarction was assessed by angiography (CAG) in emergency and, if recessary, PTCA/Stent was performed The clinical therapeutic effect and the reperfusion rate of IRA, side effects, mortatity and left ventricular function were compared with each other in the two groups Results The reperfusion rate of IRA was 64 7%(29% TIMI 2, 35 7 TIMI 3) in group A and 33% group B (18% TIMI 2, 15% TIMI 3) when the patients arrived in the cath lab The IRA of the patients who had become TIMI 3 flow was 75%(33/44)in group A and 84 2%(47/57) in group B after PTCA/Stent The left ventricular ejection fraction (LVEF) was calculated by echocardiography before 3 weeks and PTCA/Stent between the two groups The EF of the patients with TIMI 3 when arrived in the cath lab (34 patients, 24 in group A , 10 patients in Group B )was 60 8% at first time and 62 5% in second time The EF of patients who had achieved TIMI 3 after PTCA/Stent (80 patients ) was 57 0% at first time and 57 2% in second time. The EF of patients who had not achieved TIMI 3 (21 patients ) was 54 1% at first time and 53 2% in second time Conclusion Compared with the effect of primary PTCA/Stent, the thrombolytic agent rt PA 50mg plus rescue PTCA/Stent in AMI could also improve the reperfusion of IRA and left ventricular function, which could not increase side effects