急诊与择期经皮冠状动脉介入治疗急性 ST 段抬高型心肌梗死临床疗效的比较研究

摘要

Objective To compare the clinical effect on acute ST-segment elevation myocardial infarction(ASTEMI) between emergency PCI and delayed PCI. Methods A total of 388 ASTEMI patients treated by PCI were selected in the Central Hospital of Yiyang from January 2010 to June 2014,thereinto 167 patients treated by emergency PCI(within 12 hours) were served as A group,other 221 patients treated by delayed PCI(over 12 hours)were served as B group. Immediate success rate, hospital stays,incidence of cardiac events( including heart failure,malignant arrhythmia,reinfarction and cardiac death) during hospitalization and during follow - up,Killip grade,LVEF and BNP before and after treatment were compared between the two groups. The end point of follow - up was January 2015. Results The immediate success rate of A group was 96. 4% ,that of B group was 95. 8% ,the difference was not statistically significantly different(P ﹥ 0. 05). The incidence of heart failure during hospitalization of A group was statistically significantly lower than that of B group,while incidence of malignant arrhythmia during hospitalization of A group was statistically significantly higher than that of B group( P ﹤ 0. 05);no statistically significant differences of incidence of reinfarction or total cardiac events during hospitalization was found between the two groups( P ﹥0. 05);no one of the two groups occurred cardiac death during hospitalization. The hospital stays of A group was(10. 1 ± 1. 3) days,was statistically significantly shorter than that of B group of(13. 4 ± 1. 9)days(P ﹤ 0. 05). Before PCI,Killip grade of A group was statistically significantly worse than that of B group,LVEF of A group was statistically significantly lower than that of B group,BNP of A group was statistically significantly higher than that of B group(P ﹤ 0. 05);after PCI,Killip grade of A group was statistically significantly better than that of B group,LVEF of A group was statistically significantly higher than that of B group,BNP of A group was statistically significantly lower than that of B group(P ﹤ 0. 05). The incidence of heart failure, reinfarction and total cardiac events during follow - up of A group were statistically significantly lower than those of B group(P ﹤0. 05);while no statistically significant differences of incidence of malignant arrhythmia or cardiac death during follow - up was found between the two groups(P ﹥ 0. 05). Conclusion Emergency PCI can more effectively improve the cardiac function of ASTEMI patients than delayed PCI,is more helpful to reduce the incidence of cardiac events and shorten the hospital stays.%目的：比较急诊与择期经皮冠状动脉介入（PCI）治疗急性 ST 段抬高型心肌梗死（ASTEMI）的临床疗效。方法选取2010年1月—2014年6月益阳市中心医院收治的行 PCI 治疗的 ASTEMI 患者388例，将167例接受急诊 PCI（发病至 PCI 时间﹤12 h）治疗者作为急诊 PCI 组，221例接受择期 PCI（发病至 PCI 时间≥12 h）治疗者作为择期 PCI 组。比较两组患者 PCI 即刻成功率、住院时间、住院及随访期间心脏事件（心力衰竭、恶性心律失常、再梗死、心源性死亡）发生情况，PCI 前后 Killip 分级、左心室射血分数（LVEF）、脑钠肽（BNP）水平。随访时间截至2015年1月。结果急诊 PCI 组 PCI 即刻成功率为96.4%，择期 PCI 组为95.8%，差异无统计学意义（P ﹥0.05）。急诊 PCI 组患者住院期间心力衰竭发生率低于择期 PCI 组，恶性心律失常发生率高于择期 PCI 组（P ﹤0.05）；两组患者住院期间再梗死及心脏事件总发生率比较，差异无统计学意义（P ﹥0.05）；两组患者住院期间均未出现死亡病例。急诊 PCI 组患者住院时间为（10.1±1.3） d，短于择期 PCI 组的（13.4±1.9） d（ P ﹤0.05）。急诊 PCI 组患者术前Killip 分级劣于择期 PCI 组，LVEF 低于择期 PCI 组，BNP 水平高于择期 PCI 组（P ﹤0.05）；急诊 PCI 组患者术后 Killip分级优于择期 PCI 组，LVEF 高于择期 PCI 组，BNP 水平低于择期 PCI 组（P ﹤0.05）。急诊 PCI 组患者随访期间心力衰竭、再梗死及心脏事件总发生率低于择期 PCI 组（P ﹤0.05）；两组患者随访期间恶性心律失常、心源性死亡发生率比较，差异无统计学意义（P ﹥0.05）。结论急诊 PCI 较择期 PCI 能更有效地改善 ASTEMI 患者心功能，有助于减少心脏事件的发生及缩短住院时间。