延迟急诊PCI治疗急性ST段抬高型心肌梗死及患者预后的研究

摘要

目的：探讨采用延迟急诊经皮冠状动脉介入术（PCI）治疗失去早期经静脉溶栓时机的ST段抬高型心肌梗死（STE‐MI）与早期静脉溶栓成功并择期行PCI在预后中的差别。方法选取该院诊治的STEMI患者120例，并根据其PCI时机分为溶栓组和延迟组：溶栓组82例，溶栓时间距发病时间小于或等于6 h ，予瑞替普酶静脉溶栓及择期行PCI；延迟组38例，入院后即予PCI ，PCI时间距发病12～24 h。记录患者各阶段的临床症状及心电图改变，判断PCI前后梗死相关动脉（IRA ）的心肌梗死溶栓试验（TIMI）分级，比较两组患者的预后。结果 PCI后，溶栓组的 TIMI分级：0～1级为4．88％（4/82），2～3级为95．12％（78/82）；延迟组TIMI分级：0～1级为5．26％（2/38），2～3级为94．74％（36/38），两组比较差异无统计学意义（P＞0．05）。发病后3个月，两组间左心室收缩末期容积指数（LVESVI）、左心室舒张末容积指数（LVEDVI）及左室射血分数（LEVF）比较，差异无统计学意义（P＞0．05）。经治疗后延迟组严重心力衰竭发生率及恶性心律失常发生率均高于溶栓组（P＜0．05），两组间梗死后心绞痛及发病3个月后心源性病死率比较，差异无统计学意义（P＞0．05）。结论延迟急诊 PCI可尽早疏通IRA ，在心源性死亡、心肌梗死后心绞痛及发病后3个月心功能改善等方面，与发病早期溶栓成功并择期PCI无明显差异。%Objective To compare the prognosis of ST elevation acute myocardial infarction(STEMI) of delayed emergency per‐cutaneous coronary intervention(PCI) and elective PCI following the thrombolysis with reteplase ,and to investigate the clinic value of the former solution .Methods One hundred and twenty STEMI patients were reviewed retrospectively and were divided into 2 groups according to PCI .Eighty two cases were divided into emergency group :thrombolysis with reteplase offered within 6h was followed by elective PCI;38 cases were divided into delayed group:PCI was done after 12-24 h after ATEMI′occurring .The clini‐cal features and CTG changes were recorded ,TIMI class of IRA was conducted before and after PCI ,and their prognosis were com‐pared .Results There was no statistical differences in the class of thrombolysis of myocardial infarction(Class 0 -1 ,2 -3) of in‐farction relative artery (IRA)(4 .88% ,95 .12% vs .5 .26% ,94 .74% ) after PCI(P>0 .05) .There was no statistical difference in LVEF ,LVEDVI and LVESVI 3 months after attack between two groups(P>0 .05) .There was statistical difference in the severe cardiac failure and malignancy arrhythmia between two groups(P<0 .05) ,while no statistical difference exist in angina after infarc‐tion as well as cardiac mortality after attack between two groups(P>0 .05) .Conclusion Delayed emergency PCI to remove the ob‐struction in the coronary artery has no significant difference with elective PCI following thrombolysis in the incidence of composite end point events in STEMI .