AMI静脉溶栓后即行PTCA与直接冠状动脉支架术的疗效比较

Comparison of the clinical efficacy of immediate PTCA after intravenous rt-PA thrombolytic therapy and primary intracoronary stenting in acute myocardial infarction

目的 比较rt-PA(50mg)静脉溶栓后即刻行经皮腔内冠状动脉成形术与直接冠状动脉支架术治疗急性心肌梗死(AMI)的临床疗效.方法119例AMI患者随机分为AB两组.A组65例行rt-PA半量(50mg)静脉溶栓后即刻行冠状动脉血管造影,及经皮冠状动脉腔内血管成行术,B组54例行直接冠状动脉支架术.术后观察20天.结果(1)首次冠状动脉造影显示:A组梗塞相关动脉(IRA)69支,开通为54%:B组IRA 57支,开通率为15%.两组开通率相比有非常显著性差异(P<0.01).(2)A,B两组行PTCA和支架置入术后对IRA恢复TIMI Ⅲ级血流效果相同,A组100%,B组98%,两者相比无显著性差异(P>0.05).(3)病人住院10～20天,二维超声心动图显示,左心室射血分数(LVEF)达到或超过60%者,A组为88%,而B组仅占69%.两者相比有显著性差异(P<0.05).(4)脑卒中或大出血并发症两组病例均未发生.(5)住院病死率,A组3%(2/65),B组3.7%(2/54),两者相比无显著性差异(P>0.05).结论小剂量rt-PA静脉溶栓后即刻行冠状动脉成形及支架置入术与直接冠状动脉支架置入术治疗AMI临床疗效相比,前者较后者具有更早地使IRA前向血流再灌注,减低冠状动脉支架置入术中并发症发生,从而具有较好的左心室功能保护,且不增加不良事件的发生.

Objective To compare the clinical efficacy of immediate percutaneous transluminal coronary angioplasty (PTCA) after intravenous thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA) and primary intracoronary stenting in patients with acute myocardial infarction (AMI). Methods From January 1998 to July 2000,one hundred and nineteen consecutive patients with AMI underwent either immediate coronary angiogra-phy (CAG) or PTCA if it was necessary after intravenous thrombolytic therapy using rt-PA 50mg (Group A 65 patients) or primary intracoronary stenting (Group B 54 patients ) . Left ventricular ejection fractions measured by two-dimensional echocardiography and cardiac events were recorded during follow-up. Results (1) The CAG at first when patients were sent to the operation of catheter cardiac shows that the re-open rate of infarct related artery (IRA) in patients with Group A was 54% , while that with Group B was 15%. The difference between group A and group B was significant (p value <0. 01). (2) The re-open rate of IRA in operated PTCA and stenting in patients Group A and B was similar (Group A 100% ; Group B 98%). (3) At 20-days follow-up, The left ventricular ejection fraction reached or exceeded 60% was 88% in Group A, while that in Group B was 69%. The difference between group A and group B was significant (p value<0. 05). (4) The complication of cerebral hemorrhage and hemorrhage in group A and group B do not occur. (5) The mortality in hospital in group A was 3. 1%, While that in group B was 3. 7% , The difference between group A and group B was insignificant (p value > 0. 05). Conclusion Comparison of clinical curative effect with immediate PTCA after intravenous rt-PA and primary intracoronary stenting in AMI shows that the method in group A can re-open IRA earlier, decrease the complication in the operation of intracoronary stenting,protect the left ventricular ejection fraction more effectively and do not increase heart events happening that in group B.