急性心肌梗死直接、延迟及补救性PCI治疗的比较研究_医学论文.docVIP

急性心肌梗死直接、延迟及补救性PCI治疗的比较研究_医学论文 急性心肌梗死直接、延迟及补救性PCI治疗的比较研究_医学论文 作者：滕旭　吴桂平　张彦红　贾大林 【摘要】 　　目的对比急性心肌梗死成功直接、延迟及补救性PCI治疗的近期疗效和远期疗效。方法共纳入286例首发心梗患者，既往无心衰病史。按入院时间分别接受直接、延迟及补救性PCI治疗，均治疗成功。观察三组住院期间和随访期间主要心脏不良事件（MACE,即死亡、再发心绞痛、再次梗死、心力衰竭）和超声心动图的变化。结果住院期间三组患者各项心脏事件差异均无显著性（P＞0.05），复合终点事件发生率，差异亦无显著性。平均随访（13.1 ± 3. 5）个月时，三组患者在死亡、不稳定型心绞痛、再次梗死发生率方面无明显差异（P＞0.05），但心力衰竭和复合终点事件发生率，补救PCI 组明显下降（ 0.05）。左心室射血分数及左心室短轴缩短率，溶栓后补救性PCI组明显大于延迟PCI组（ 0.05）。延迟PCI 组和直接PCI 组差异无显著性（P＞0.05）。左心房内径及左心室舒张末内径，溶栓后补救性PCI组显著低于延迟PCI组（ 0.05），延迟PCI 组和直接PCI 组差异无显著性（P＞0.05）。结论静脉溶栓联合PCI治疗AMI可实现IRA的尽早、充分、持久开通，可获得与直接PCI相同冠脉造影疗效的同时患者左心室功能显著改善，并不增加MACE。 【关键词】 急性心肌梗死　介入治疗　预后 　　 Effection of direct、delayed and thrombolysis plus percutaneous coronary intervention TENG Xu，WU Gui-Ping，ZHANG Yan-hong，et al.Department of Cardiology,Shenzhou Hospital Affiliated to Shenyang Medical College, Shenyang 110002,China 【Abstract】ObjectiveTo evaluate the curative effect on acute myocardial infarction in the short-term and long-term stage：direct、delayed and complementary percutaneous coronary intervention （PCI）.MethodsA total of 286 PCI patients with AMI were divided into 3 groups: direct PCI, delayed PCI and thrombolysis plus PCI according to the patients registration date. There was no record of heart failure occurrence in the case history for all of them,and all of them are treated successfully. During hospitalization and follow-up period we observed major adverse cardiac events (MACE: death, recurrent angina, re-infarction, heart failure) and the echocardiography changes of the three group patients.ResultsDuring hospitalization the incidence of MACE and composite end point event rate were not different in the 3 groups (Pgt 0.05). The incidence of death, unstable angina and re-infarction were not different in the 3 groups during（13.1±3.5）months follow-up period (Pgt0.05). But the incidence of heart failure, composite end point event were significantly decreased (0.05) in thrombolysis plus PCI group. The left ventricular ejection fract