摘要
目的 评价对ST段抬高急性心肌梗死 (AMI)患者直接经皮冠状动脉介入治疗 (PCI)的临床疗效。方法 将 2 0 0 0年 4月至 2 0 0 4年 4月入院的 4 5 8例ST段抬高AMI患者 ,非随机分为有创组 (PCI治疗 ) 2 0 5例和无创组 (静脉溶栓或药物保守治疗 ) 2 5 3例 ,比较两组死亡率、主要心血管事件发生率、再梗死率以及第 2周超声心动图检查左室舒张末期前后径 (EDD)和左心室射血分数 (LVEF) ,并根据冠状动脉造影结果 ,分成单支、双支、三支病变组 ,探讨不同病变支数对左室功能的影响。结果 2 0 5例PCI患者中 ,术中造影显示单支血管病变 6 6例 (32 2 % ) ,双支病变 6 8例 (33 2 % ) ,三支病变 71例 (34 6 % ) ,手术成功率 99% ,共置入支架 2 2 8枚 ,术后 194例 (94 6 % )患者梗死相关动脉 (IRA)达TIMI 3级血流 ;有创组与无创组比较 ,住院 30d死亡率为 2 9%vs 9 1% (P <0 0 1) ,主要心血管事件发生率为 9 8%vs2 6 5 % (P <0 0 0 5 ) ,再梗死率为 2 0 %vs8 7% (P <0 0 0 5 ) ;有创组第 2周超声检查LVEF水平显著高于无创组 [(5 9 87%± 8 32 % )vs (5 4 4 3%± 10 2 1% ) ,P <0 0 0 1],EDD水平显著低于无创组 [(5 3 0 2± 5 5 1)mmvs (5 6 82± 7 6 6 )mm ,P <0 0 0 1];有创组中单支血管病变组的LVEF比?
Objective To evaluate the clinical efficacy of direct percutaneous coronary intervention (PCI) in ST segment elevation acute myocardial infarction (AMI) Methods From April 2000 to April 2004, 458 patients with ST segment elevation AMI were randomized to receive invasive therapy ( n =205) or non invasive therapy ( n =253) Comparison was made in the 30 day mortality rate, major cardiac events rate, reinfarction rate during hospitalization, left ventricular ejection fraction (LVEF) and end diastolic diameter (EDD) of echocardiograph in 2 weeks after AMI between the 2 groups The PCI group was divided into 3 sub groups according to number of stenosis artries found during angiography We try to find not the relation between left ventricular function and the number of coronary artery with stenosis Results The result of selective coronary artery angiography in 205 PCI patients was: 66 patients with single branch lesion (32 2%), 68 patients with double branches lesion (33 2%) and 71 patients with triple branches lesion (34 6%) 203 patients were operated successfully (99%), 228 stents were placed on lesions, 194 patients (94 6%) obtained TIMI grade Ⅲ perfusion of the IRA Compared the invasive with the non invasive group, the in hospital 30 day mortality rate was 2 9% vs 9 1% ( P <0 01), major cardiac events rate was 9 8% vs 26 5% ( P <0 005), and reinfarction rate was 2 0% vs 8 7% ( P <0 005) respertively The LVEF in the invasive group was significantly higher than that in the non invasive group after 2 weeks ( P <0 001), but the EDD was lower in the invasive group than in the controls ( P <0 001) The LVEF was significantly higher in patients with single branch lesion than in patients with multi branch lesions group ( P <0 01), but EDD responded in the opposite direction ( P <0 01) Conclusion Direct PCI could rapidly and efficaciously reperfuse the infarction relational artery, rescue the dying myocardium and improve left ventricular func
出处
《中国介入心脏病学杂志》
2004年第6期348-351,共4页
Chinese Journal of Interventional Cardiology
