梗死前心绞痛对急性心肌梗死患者直接PCI术后的影响

Effects of preinfarction angina on patients with acute myocardial infarction after direct percutaneous coronary intervention

目的 探讨梗死前心绞痛对首次急性心肌梗死 (AMI)患者直接经皮冠状动脉介入治疗 (PCI)术后的近期影响。方法 10 0例首次 AMI患者 ,按梗死前有无心绞痛史分为 A(有心绞痛史 ,5 5例 )、B(无心绞痛史 ,4 5例 ) 2组 ,所有患者均在发病 12 h内行直接 PCI术。术前术后监测心肌酶变化 ;术后 2周行心血池显像测定左心室射血分数。并观察住院期间心律失常、心力衰竭或心源性休克的发生率及再梗死率、病死率。结果 (1) A组肌酸激酶同工酶峰值低于 B组 (P<0 .0 5 )。 (2 ) A组自溶现象发生率高于 B组 (P<0 .0 5 ) ;A组无再流现象发生率低于 B组 (P<0 .0 5 )。 (3) A组左心室射血分数高于 B组 (P<0 .0 5 )。 (4 ) A组心力衰竭或心源性休克的发生率和再梗死率均低于B组 (P<0 .0 5 )。结论 梗死前心绞痛可促进 AMI患者梗死相关动脉自溶现象的产生 ,并可减少直接 PCI术后无再流现象的发生 。

Objective To evaluate short-time effects of preinfarction angina on patients with first acute myocardial infarction(AMI) after direct percutaneous coronary intervention(PCI). Methods One hundred patients with first AMI were divided into preinfarction angina group (A group, n=55) and no preinfarction angina group (B group, n=45). All patients undervent direct PCI within 12h after onset of AMI. Myocardial enzyme was continuously measured. Equilibrium radionuclide angiography was performed to detect left ventricular ejection fraction(LVEF) at 2 weeks. The incidence of arrhythmia,heart failure,cardiogenic shock,reinfarction and mortality in hospitalization were observed. Results (1) The peak creatine MB fraction was lower in group A than that in group B(P< 0.05).(2) The incidence of spontaneous recanalization (SR) of infarct related artery (IRA) was higher in group A than that in group B (P<0.05); The incidence of no-reflow phenomenon was lower in group A than that in group B(P<0.05). (3) LVEF was higher in group A than that in group B (P<0.05). (4) The incidence of heart failure or cardiogenic shock,reinfarction were lower in group A than that in group B (P<0.05). Conclusion Preinfarction angina is favorable for SR of IRA and can inhibit no-reflow phenomenon after direct PCI in AMI patient,which improve ventricular function and short-time prognosis.