延迟PCI与直接PCI治疗急性心肌梗死的比较

Comparison between primary PCI and delayed PCI in patients with acute myocardial infarction

目的 探讨经皮延迟冠脉介入 (PCI)与直接PCI在治疗急性心肌梗死 (AMI)疗效的差异。方法 14 5例连续行PCI的AMI患者分为直接PCI组 (75例 )和延迟PCI组 (70例 ) ,分析两组患者一般临床特征及心血管事件的发生率。结果 住院期间两组患者各项心脏事件均无显著差异。平均随访 (12 1± 4 5 )个月时 ,直接PCI组患者在不稳定性心绞痛 (9 3%vs 32 9% ,P <0 0 1)、非致死性心衰 (4 0 %vs14 3% ,P <0 0 5 )、死亡 (0vs 7 1% ,P <0 0 5 )及复合终点事件 (12 %vs 4 0 % ,P <0 0 1)方面较延迟PCI组明显降低。但两组间在非致死性再次心肌梗死、缺血性靶血管重建及总的心脏性死亡率无显著差异。近期内LVEF值延迟PCI组较直接PCI组显著降低 (0 5 8± 0 14vs 0 6 3± 0 10 ,P <0 0 5 )。结论 与直接PCI相比 ,延迟PCI治疗AMI近期内同样安全有效 ,1年死亡率无显著降低 ,但不稳定性心绞痛、非致死性心衰、死亡及复合终点事件发生率增加。

Objectives To evaluate the diffe-rent effects between primary PCI and delayed PCI in acute myocardial infarction(AMI). Methods One hundred and forty five consecutive patients with AMI treated by percutaneous coronary intervention(PCI) were devided into primary PCI group(75 cases) and delayed PCI group(70 cases). The baseline characte- ristics and cardiac events were analysed. Results No significant difference was observed in the contex in-hospital cardiac events between the two groups. During follow-up period(mean 12.1±4.5 months), unstable angina(9.3% vs 32.9%, P <0.01), non-fatal heart failure(4.0% vs 14.3%, P <0.05), mortality rate (0 vs 7.1%, P <0.05) and composite events(12% vs 40%, P <0.01) decreased significantly in primary PCI group than in delayed PCI group, but there were no significant difference in non-fatal reinfarction and ischemic target vessel revascularization in the two groups( P >0.05). The left ventricular ejection fraction(LVEF) was lower(0.58±0.14 vs 0.63±0.10, P <0.05) in delayed PCI group than in primary PCI group. Conclusions The AMI patients treated by delayed PCI exhibit both safe and effective as by primary PCI in early period, and one-year mortality rate didn't reduce, but unstable angina, non-fatal heart failure, mortality rate and composite events increased.