溶栓后即刻PCI与直接PCI对STEMI患者术后心室重构及心功能的对比研究

Comparative study of ventricular remodeling and cardiac function between immediate PCI after thrombolysis and primary PCI in STEMI patients

目的探讨溶栓后即刻经皮冠状动脉介入术(PCI)与直接PCI对急性ST段抬高型心肌梗死(STEMI)患者术后心室重构及心功能的影响。方法回顾性分析2017年2月~2019年7月首都医科大学宣武医院123例行PCI治疗的STEMI患者的临床病历资料,根据手术方案将其分为溶栓后即刻PCI组(A组,n=67)和直接PCI组(B组,n=56)。比较两组患者治疗前、治疗14 d后的心室重构指标以及左心室功能指标、血清生物标志物水平如肌酸激酶同工酶(CK-MB)、金属基质蛋白酶-9(MMP-9)、N-末端脑钠肽前体(NT-proBNP)。结果两组患者治疗14 d后左心室舒张期末容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)均低于治疗前,左心室收缩功能(LVSF)高于治疗前,差异均有统计学意义(均P <0.05)。两组患者治疗14 d后LVEDVI、LVESVI、LVSF比较,差异无统计学意义(P> 0.05)。两组患者治疗14 d后的左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、峰射血率(PER)、峰充盈率(PFR)均高于治疗前,左心室舒张末期内径(LVEDD)低于治疗前,差异均有统计学意义(均P <0.05)。A组治疗14 d后的LVEF、LVESD高于B组,LVEDD低于B组,差异均有统计学意义(均P <0.05)。治疗14 d后两组患者CK-MB、MMP-9、NT-proBNP水平均低于治疗前,差异均有统计学意义(均P <0.05);A组治疗14 d后的CK-MB、MMP-9、NT-proBNP水平均低于B组,差异均有统计学意义(均P <0.05)。结论溶栓后即刻PCI与直接PCI均可改善STEMI患者心室重构和心功能,但溶栓后即刻PCI对心功能改善更为显著,尤其值得临床推荐应用。

Objective To explore the effects of immediate percutaneous coronary intervention(PCI)after thrombolysis and primary PCI on postoperative ventricular remodeling and cardiac function in patients with acute ST segment elevation myocardial infarction(STEMI).Methods The clinical data of 123 patients with STEMI in Xuanwu Hospital,Capital Medical University from February 2017 to July 2019 were retrospectively analyzed,who were divided into immediate PCI group after thrombolysis(group A,n=67)and primary PCI group(group B,n=56)according to the surgical protocol.The indexes of ventricular remodeling and left ventricular function and the levels of serum biomarkers such as creatine kinase isoenzyme(CK-MB),matrix metalloproteinase-9(MMP-9),N-terminal pro-brain natriuretic peptide(NT-proBNP)before and after 14 days of treatment were compared between the two groups.Results The left ventricular end-diastolic volume index(LVEDVI)and left ventricular end-systolic volume index(LVESVI)of the two groups after14 days of treatment were lower than those before treatment,and the left ventricular systolic function(LVSF)was higher than that before treatment,with statistically significant differences(all P<0.05).There were no significant differences in LVEDVI,LVESVI and LVSF between the two groups after 14 days of treatment(P>0.05).The left ventricular ejection fraction(LVEF),the left ventricular end-systolic dimension(LVESD),peak ejection rate(PER),peak firing rate(PFR)of two groups after 14 days of treatment were significantly higher than those before treatment,and left ventricular enddiastolic diameter(LVEDD)was lower than that before treatment,with statistically significant differences(all P<0.05).After 14 days of treatment,LVEF and LVESD in group A were higher than those in group B,and LVEDD was lower than that in group B,with statistically significant differences(all P<0.05).After 14 days of treatment,the levels of CK-MB,MMP-9 and NT-proBNP in the two groups were all lower than those before treatment,and the differences were statistically significant(all P<0.05).The levels of CK-MB,MMP-9 and NT-proBNP in group A after 14 days of treatment were all lower than those in group B,and the differences were statistically significant(all P<0.05).Conclusion Both immediate PCI after thrombolysis and primary PCI can improve ventricular remodeling and cardiac function in STEMI patients,but immediate PCI after thrombolysis can significantly improve cardiac function,which is especially worthy of clinical recommendation.