急性ST段抬高型心肌梗死患者溶栓成功后最佳介入治疗时机的探讨

Optimal timing for percutaneous coronary intervention after successful fibrinolysis in ST-segment elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者静脉溶栓成功后介入治疗的最佳时机。方法116例外院静脉溶栓成功后转入我院的STEMI患者,于溶栓后2~24 h内行经皮冠状动脉介入治疗(PCI),根据溶栓至PCI时机的不同分为早期介入(2~5 h)组58例,晚期介入(5~24 h)组58例。比两组一般资料、术后3 d和术后30 d的左室射血分数(LVEF)以及左室舒张末径(LVDd)、术后30 d及1年的不良事件包括:死亡、再梗、出血、再发心肌缺血、新发心衰的发生情况。结果两组一般资料中发病至介入时间早期介入组(7.16±2.32)h和晚期介入组(16.02±7.18)h差异有统计学意义(P<0.001);术后3 d和30 d的LVEF,早期介入组均较晚期介入组显著升高[(49.59±6.34)%vs.(46.55±7.14)%,P=0.017;(52.63±5.19)%vs.(49.57±5.72)%,P=0.003];术后3 d和术后30 d的LVDd,早期介入组均较晚期介入组显著减小(48.41±6.88)mm vs.(51.82±5.40)mm,P=0.004;(47.59±5.01)mm vs.(52.06±5.95)mm,P=0.001;术后30 d早期介入组心脏复合终点事件(包括死亡、再梗、再发心肌缺血、脑卒中、新发心衰)总发生率(19%)显著低于晚期介入组(36%),差异有统计学意义(P=0.038)。结论STEMI患者静脉溶栓成功后2~5 h内行PCI有利于心功能恢复,改善预后。

Objective To explore the best time for percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI)after successful fibrinolysis.Methods 116 patients with STEMI were transferred to our hospital after successful fibrinolysis,and were treated with PCI 2~24 hours after thrombolysis.According to the time of thrombolysis to PCI,patients were divided into early group(2~5 h,n=58)and late group(5~24 h,n=58).The baseline data,left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVDd)after PCI 3 days and 30 days of the two groups were compared.Adverse events after PCI 30 days and 1 year including death,recurrent infarction,bleeding,recurrent myocardial ischemia,stroke,new heart failure were assessed.Results The time of onset to PCI between the early group(7.16±2.32)h and the late group(16.02±7.18)h were significant different(P<0.001).LVEF after PCI 3 days and 30 days were higher in the early group than that in the late group(49.59±6.34)%vs.(46.55±7.14)%,P=0.017;(52.63±5.19)%vs.(49.57±5.12)%,P=0.003).LVDd after PCI 3 days and 30 days were decreased in the early group than that in the late group[(48.41±6.88)mm vs.(51.82±5.40)mm,P=0.004,(47.59±5.01)mm vs.(52.06±5.95)mm,P=0.001.In 30 days after PCI,the total incidence of cardiac composite endpoint(including death,recurrent infarction,recurrent myocardial ischemia,stroke,new heart failure)in the early group(19%)was significantly lower than that in the late group(36%),P=0.038.Conclusion PCI in STEMI patients in 2~5 hours after successful fibrinolysis is beneficial to the recovery of cardiac function and improve prognosis.