急性心肌梗死不同时间窗急诊经皮冠状动脉介入疗效比较.docVIP

急性心肌梗死不同时间窗急诊经皮冠状动脉介入疗效比较

上海市浦东新区公利医院心内科林捷邱建平陆纪德葛智儒龚佩华王海容窦桂珍

(邮编200135)

上海交通大学医学院附属瑞金医院心脏科沈卫峰张奇(邮编200025)

【摘要】目的评价急性ST段抬高心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）时间延迟与预后的关系。方法选择2004年1月至2006年9月确诊STEMI且行急诊PCI的患者153例，根据症状发生至第一次球囊扩张的时间间隔分为两组：A组，112例，6小时内；B组41例，6-12小时。记录PCI后ST段回落70％的梗死相关导联数，住院期和1年随访的左室射血分数、心脏主要不良事件。结果A组PCI后ST段回落70％的梗死相关导联数显著高于B组(P0.05),与B组比较，A组随访期间左室射血分数增高，心脏主要不良事件发生率显著降低(P0.05)。结论STEMI后6小时内行直接PCI能改善心肌灌注、促进左室功能恢复，显著降低总心脏主要不良事件的发生率。

【关键词】急性心肌梗死；直接经皮冠状动脉介入治疗；预后

ImpactofdifferenttreatmenttimesonprognosisofPrimarypercutaneousCoronaryInterventionforacutemyocardialinfarction

LINJie，QIUJianping，LUJide，GEZhiru，GONGPeihua，

WANGHairong，DOUGuizhen

(DepartmentofCardiology,ShanghaiPudongGongliHospital,Shanghai200135,China

【Abstract】Objective:ToevaluatetheimpactofdifferenttreatmenttimesonprognosisofPrimarypercutaneousCoronaryInterventionforacutemyocardialinfarction.Methods:Atotleof153AMIpatientswereenrolledfromJanuary2004toSeptember2006andfollowedupfora.year.AccordingtotheSymptom-onset-to-ballontime,thepatientswerecategorizedinto:≤6hours（groupA）and6∽≤12hours(groupB).Results:Therewasasimilarclinicalandcoronarycharacteristicbetweentwogroups.Allshowedstatisticallyinsignificant.Therewerenodifferencesinin-hospitaland1-yearmortalitybytimetoreperfusion(in-hospitalmortality:3.57％vs4.87%P0.05;1-yearmortality:1.78％vs2.43%P0.05).Earlierreperfusion（≤6hours

vs6∽≤12hours)wasassociatedwithlesstotalmainadversecardiacevents(MACE)(10.71％vs24.39％,P0.05),morefrequentcompleteST-segmentresolution(68.75％vs51.22％％,P0.05);andgreaterimprovementinleftventricularfunction.Conclusions:DirectPCI≤6hafteronsetofsymptomsresultsinsignificantlyreducetotalMACE，enhancedmicrovadcularreperfusion，andbetterrecoveryofleftventricularfunction.

【KEYWORDS】acutemyocardialinfarction;primarypercutaneouscoronaryinterv