急性心肌梗死延迟PTCA对心肌灌注的影响

The effects of delayed percutaneous transluminal coronary angioplasty plus intracoronary stents on myocardial perfusion in patients with acute myocardial infarction

目的 研究急性心肌梗死延迟经皮冠状动脉腔内成形术 (PTCA)及支架植入对心肌灌注的影响。方法 5 6例初次急性心肌梗死患者随机分为PTCA及支架植入组 (治疗组 ,3 0例 )和常规药物治疗组 (对照组 ,2 6例 )。治疗组在急性心肌梗死后 15～ 3 0d行延迟PTCA及支架植入治疗。治疗组于术前 1～ 3d、对照组于急性心肌梗死后 15～ 3 0d行SPECT心肌灌注显像 ,1和 6个月各复查SPECT检查 1次。结果 治疗组术后 1和 6个月梗死区缺血程度均较术前明显改善 (P <0 .0 1) ,术后差异无显著性 (P >0 .0 5 )。对照组第 2、3次检查示心肌缺血均较第 1次稍有改善 ,但差异均无显著性(P >0 .0 5 )。治疗组较对照组心肌缺血明显改善 (P <0 .0 5 )。。结论 急性心肌梗死患者延迟PTCA及支架植入能使梗死相关血管再通 ,血运重建 。

Objective To assess the myocardial perfusion in patients with acute myocardial infarction (AMI) after delayed percutaneous transluminal coronary angioplasty (PTCA) and intracoronary stent implanting. Methods Fifty-six patients with AMI were divided into delayed PTCA+stent group (treatment group, n=30) and control group (n=26). The treatment group were received delayed PTCA and coronary artery stents 15～30 d after AMI. The first 99Tc m-MIBI was performed 1～3 d before PTCA+stent (treatment group) and 15～30 d after AMI (control group), and followed by the second (1 month later), and the third (6 months later) 99Tc m-MIBI. Results One month and six months after the treatment procedure (PTCA + stent), the blood flow deficit degree of myocardial infarction area in treatment group was much improved comparing with that before the procedure (treatment group, P<0.01) and that in control group(P<0.05). But there was no significant differences between the results at one month and six months after the treatment (P>0.05). Conclusions There is residual myocardial viability in the AMI regions and PTCA+ stent implantation keeps more joepardized myocardium viable. Active therapy after AMI can significantly improve myocardial perfusion.