延期冠心病介入治疗对急性心肌梗死患者中远期左室功能及预后的影响

Mid-to long-term effects of delayed percutaneous coronary intervention on left ventricular function and prognosis in patients with acute myocardial infarction

目的探讨延期冠心病介入治疗(PCI)对急性心肌梗死(AMI)患者中远期左室功能和预后的疗效.方法选择AMI1～2周内的42例患者行PCI(冠状动脉腔内血管形成术+支架植入术),设同期住院的仅药物治疗的31例AMI患者作对照组,观察两组心肌梗死后1个月、6个月的死亡,再梗死、心绞痛再发(包括心肌梗死后心绞痛)及超声心动图检查.结果介入治疗组1个月时较对照组左室收缩功能明显改善(P＜0.01),6个月时更进一步改善(P＜0.01),并且无死亡、再梗死,仅有1例心绞痛复发(术后5月时),而对照组死亡2例,再梗死1例,心绞痛再发4例(其中心肌梗死后心绞痛2例).结论AMI患者经延期PCI治疗,显著改善其预后、延长无心血管事件生存期及左室功能,手术成功率高.

Objective To investigate the mid- to long-term effects of delayed percutaneous coronary intervention (PCI) on theleft ventricular function and clinical outcome of patients with acute myocardiol infarction (AMI). Methods PCI (includingpercutaneous transluminal coronary angioplasty and stenting) was performed in 42 patients within 1 to 2 weeks following theonset of AMI (PCI group), with another 31 patients who were admitted within the same period to receive medication for AMIserving as the control group. The patients in both groups were observed for comparison of the occurrence of reinfarction andangina, mortality at 1 and 6 months, and findings by ultrasound cardiograms (UCG). Results In PCI group, the left ventricularfunction were obviously improved as compared with the control group (P<0.01) 1 month after the onset of AMI, showinggreater improvement at 6 months (P<0.01). No death or reinfarction occurred in the PCI group, with only 1 patients experien-cing angina 5 months after PCI. In control group, death occurred in 2 cases, reinfarction in 1 case, recurrent angina in 4 cases (include 2 cases of early postinfarction angina). Conclusion Delayed PCI may significantly improve the prognosis of patientswith AMI and prolong their survival without cardiovascular accidents and ameliorate their left ventricular functions, with highsuccess rate of the operation.