急诊PCI与择期PCI治疗急性心肌梗死的临床对比分析

Clinical comparative analysis between emergency PCI and elective PCI in acute myocardial infarction treatment

目的 比较急诊与择期经皮冠状动脉介入（PCI）术治疗稳定期急性心肌梗死患者的临床疗效。方法 选择2012年1月~2014年12月在我院收治的明确诊断为稳定期急性心肌梗死患者共164例，随机分为急诊组和择期组，急诊组于就诊当日行急诊PCI，择期组常规药物治疗7 d后行PCI术。治疗前、治疗1个月及3个月时行超声心动图测定两组患者左心室重构和收缩功能指标，比较两组患者住院时间、PCI术即刻成功率、住院期间及出院后随访期间（出院3个月）心脏事件发生情况。结果 治疗1个月和治疗3个月时急诊组患者左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）均较择期组显著降低（P＜0.01），而左室射血分数（LVEF）较择期组显著升高（P＜0.01）；急诊组患者PCI术即刻成功率较择期组显著提高（P＜0.01），住院时间显著缩短（P＜0.01）；急诊组患者住院期间及出院后随访期间（术后3月内）心力衰竭发生率及心脏事件总发生率均较择期组显著降低（P＜0.01）。结论 急诊PCI术较择期PCI术更有效改善稳定期急性心肌梗死患者心室重构和心脏功能，减少心脏事件的发生及缩短住院时间。

Objective To compare the effectiveness of emergency PCI and Elective PCI in treating acutemyocardial infarction patients. Methods A total of 164 patients with stable acute myocardial infarction, who visitedour hospital in January 2012-December 2014, were randomly divided into emergency group and selective group.Patients of emergency group received PCI on the day of emergency, and patients of selective group received PCIafter routine treatment for 7 days. Indictors of left ventricular reconstitution and contractive function were measuredby ultrasonic cardiogram before, after 1 month and 3 months’ treatment. Hospital stays, immediate success rate ofPCI, cardiac events during hospitalization and follow-up (3 months after discharged from hospital) were compared.Results Compared with selective group, left ventricular end-diastolic volume (LVEDV) and left ventricular endsystolicvolume (LVESV) in emergency group were significantly decreased after 1 month and 3 months’ treatment (P<0.01); left ventricular ejection fraction (LVEF) was significantly increased (P<0.01); immediate success rate of PCI was significantly increased (P<0.01); hospital stays was significantly decreased (P<0.01); the rates of cardiac failureand total cardiac events during hospitalization and follow-up were significantly decreased (P<0.01). ConclusionEmergency PCI can significantly improve the left ventricular reconstitution and contractive function, reduce theoccurrence of cardiac events and shorten the hospital stay in patients with stable acute myocardial infarction.