曲美他嗪对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术后左心室功能和运动耐量的影响

摘要

目的 探讨曲美他嗪对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入(PCI)术后左心室功能和运动耐量的影响.方法 选取2012年3月至2015年2月于北京市垂杨柳医院心脏中心明确诊断为急性ST段抬高型心肌梗死且行急诊PCI治疗的患者187例,完全随机分为对照组(94例)和曲美他嗪组(93例).对照组PCI术后给予常规治疗;曲美他嗪组在常规治疗基础上于术后2周加用曲美他嗪口服治疗.随访12个月,记录心绞痛发作及主要心脏不良事件(MACE)发生情况,记录PCI术后2周及3、6、12个月时的左心室射血分数(LVEF)和6 min步行距离.结果 最终纳入对照组85例(94例中失访9例)和曲美他嗪组83例(93例中失访6例,1例对曲美他嗪有消化道反应而停用,3例自行停药).曲美他嗪组术后12个月心绞痛发作率明显低于对照组[7.2％ (6/83)比17.6％ (15/85)] (P ＜0.05).2组MACE发生率差异无统计学意义(P＞0.05).PCI术后2周及3个月时2组LVEF及6 min步行距离差异无统计学意义(P＞0.05);6、12个月时曲美他嗪组LVEF及6 min步行距离明显高于(长于)对照组(均P＜0.01).结论 急性ST段抬高型心肌梗死患者急诊PCI术后服用曲美他嗪治疗可以改善心功能,提高运动耐量.%Objective To investigate the effect of trimetazidine on left ventricular function and exercise tolerance in acute ST-elevation myocardial infarction (STEMI) patients after emergency percutaneous coronary intervention(PCI).Methods A total of 187 STEMI patients who had emergency PCI from March 2012 to February 2015 in Beijing Chuiyangliu Hospital were randomly divided into control group(94 cases) and trimetazidine group (93 cases).Both groups were treated with conventional therapy after PCI;the trimetazidine group took trimetazidine since 2 weeks after PCI.Occurrences of angina pectoris and major adverse cardiac events (MACE) were observed during 12 months of follow-up.Left ventricular ejection fraction (LVEF) and 6-min walk distance were recorded 2 weeks and 3,6,12 months after PCI.Results Finally 85 cases in control group(9 cases lost to follow-up) and 83 cases in trimetazidine group(6 cases lost to follow-up,1 case had gastrointestinal reaction and withdrew from the trail,3 cases stopped taking drugs) were analyzed.The 12-month angina pectoris rate in trimetazidine group was significantly lower than that in control group [7.2％ (6/83) vs 17.6％ (15/85)] (P ＜ 0.05).The MACE rate had no significant difference between groups(P ＞0.05).LVEF and 6-min walk distance had no significant differences between groups 2 weeks and 3 months after PCI(P ＞ 0.05).LVEF and 6-min walk distance 6,12 months after PCI in trimetazidine group were significantly higher(longer) than those in control group (P ＜ 0.01).Conclusion Post-PCI use of trimetazidine in ST-elevation myocardial infarction patients helps improve heart function and increase exercise tolerance.