摘要
目的 :通过与经静脉溶栓治疗相比较探讨原发性支架植入术 (primarystenting)治疗急性心肌梗死 (acutemyocardialinfarc tion ,AMI)的远期疗效。方法 :1999年 1月～ 2 0 0 1年 12月在我院接受再灌注治疗 (经静脉溶栓治疗或原发性支架植入术 )的AMI患者 134例 ,其中 79例患者接受原发性支架植入术治疗 ,5 5例患者接受经静脉溶栓治疗。结果 :支架组的即刻血管再通率明显高于溶栓组 (98.7%vs.74 .5 % ,P <0 .0 0 1) ;远期随访 2 2 .3± 10 .9个月 ,支架组的心源性死亡率低于溶栓组 (7.6 %vs.2 0 .0 % ,P <0 .0 5 ) ,靶血管血运重建 (target-vesselrevascularization ,TVR)率明显低于溶栓组 (3.8%vs .32 .7% ,P <0 .0 0 1) ,主要心血管事件 (majoradversecardiacevents,MACE)发生率明显低于溶栓组 (15 .2 %vs.5 6 .4 % ,P <0 .0 0 1)。Cox比例风险模型多变量生存分析显示原发性支架植入术可显著降低远期心源性死亡率 (P =0 .0 34,OR =0 .2 99)和MACE发生率 (P =0 .0 0 1,OR =0 .2 19)。结论 :原发性支架植入术能有效的开通梗死相关血管 ,减少TVR 。
Objective: To assess the long-term clinical outcome of primary stenting in acute myocardial infarction(AMI) compared with intravenous thrombolysis. Methods: From January 1999 to December 2001, a total of 134 consecutive patients with AMI were enrolled in this study. All the patients were treated with re-perfusion therapy (intravenous thrombolysis or primary stenting). Among the 134 patients, 79 underwent primary stenting and 55 were given intravenous thrombolysis. The occurrence of death, heart failure, myocardial infarction, and target-vessel revascularization(TVR) were compared with the mean follow-up duration of 22.3±10.9months. Results: Compared to thrombolysis therapy, primary stenting resulted in higher rate of recanalization(98.7% vs.74.5%,P<0.001). At long-term follow-up, primary stenting was associated with a lower cardiac mortality (7.6% vs.20.0%,P=0.034) and reduced infarct-related coronary artery revascularization(3.8% vs.32.7%,P<0.001) compared to thrombolysis. A significant lower incidence of major adverse cardiac events(MACE) was found in the stenting group compared with that in the thrombolysis group (15.2% vs.56.4%,P<0.001). Primary stenting was the independent predictor of the occurrence of death (P=0.034,OR=0.299) and MACE (P=0.001,OR=0.219) at COX multivariable analysis. Conclusion:Primary stenting can recanalize the infarct-related coronary artery effectively. At long-term follow-up, primary stenting can reduce the occurrence of TVR, death and MACE compared to thrombolysis therapy.
出处
《中国临床医学》
2004年第4期475-477,共3页
Chinese Journal of Clinical Medicine
基金
上海市医学发展基金重点研究课题项目 (No :2 0 0 0IZD0 0 2 )
