摘要
目的比较急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)溶栓后TIMI血流Ⅲ级患者早期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)和择期PCI的临床疗效。方法入选153例在外院行溶栓治疗成功后转入长沙市中心医院行冠状动脉造影(coronary angiography,CAG)示梗死相关血管TIMI血流Ⅲ级的STEMI患者,根据处理措施分为早期PCI组(即溶栓后24 h内行PCI者,74例)和择期PCI组(起病7~9 d后行择期PCI者,79例)。比较两组患者30 d死亡率、再发心肌梗死、再发心肌缺血症状、新发心力衰竭或心力衰竭加重、心源性休克,6个月和12个月再发心肌梗死、死亡,以及住院期间出血并发症的发生情况。结果早期PCI组行PCI的患者共70例(70/74,94.6%),择期PCI组行PCI的患者共67例(67/79,84.8%),两组患者PCI所占比例比较,差异有统计学意义(P=0.048)。早期PCI组血栓抽吸[17.1%(12/70)比6.0%(4/67),P=0.024]、PCI术中及术后使用替罗非班[81.4%(57/70)比64.2%(43/67),P=0.003]患者所占比例均显著高于择期PCI组,差异均有统计学意义;术中慢血流无复流[8.6%(6/70)比1.5%(1/67)]患者比例在早期PCI组中亦有升高趋势,但差异无统计学意义(P=0.117)。早期PCI组和择期PCI组患者终点事件发生率在随访30 d[12.2%(9/74)比13.9%(11/79),P=0.747]、6个月[8.1%(6/74)比7.7%(6/78),P=0.924]、12个月[10.8%(8/74)比11.5%(9/78),P=0.887]时分别比较,差异均无统计学意义。早期PCI组住院期间出血事件较择期PCI组[17.6%(13/74)比12.7%(10/79)]升高,但差异无统计学意义(P=0.396)。结论 STEMI溶栓成功后CAG示梗死相关血管TIMI血流Ⅲ级的患者,早期PCI不能降低30 d死亡、再发心肌梗死及心力衰竭发生率,对长期死亡率及再发心肌梗死发生率亦无明显改善,且可能增加手术并发症。
Objective To compare the clinical efficacy between Percutaneous Coronary Intervention( PCI) within 24 hours and at 1 week in acute ST elevation myocardial infarction( STEMI) patients who had achieved TIMI 3 flow after fibrinolysis. Methods The study included 153 STEMI patients who had resumed TIMI 3 flow after receiving fibrinolytic therapy at first medical consult centers that did not have the capability of performing PCI. All patients were transferred to our hospital and CAG was performed within 3- 24 hours after fibrinolysis. Patients in the early PCI group( n = 74) received DES inplantation within 24 hours after fibrinolysis and patients in the elective PCI group( n = 79) received PCI 7- 9 days after STEMI onset. The clinical features PCI and the primary end points including death,reinfarction,recurrent ischemia,new or worsening congestive heart failure,or cardiogenic shock within 30 days,the incidence of bleeding in hospital,death and reinfarction after 6 and 12 months were recorded and compared between the 2 groups.Results Patients in the early PCI group had higher utilization rates of thrombus aspiration( 17. 1% vs.6. 0%,P = 0. 024) and application rates of tirofiban( 81. 4% vs. 64. 2%,P = 0. 003) as compared to the elective PCI group. The phenomena of "no reflow " and the incidence of bleeding events were similar between the 2 groups. There were no statistical differences between the 2 groups in rates of mortality,reinfarction,heart failure and cardiogenic shock at 30 days,6 months and 1 year. Conclusions Among STEMI patients with TIMI 3 flow after fibrinolysis treatment,early PCI could not reduce the incidence of death,reinfarction and heart failure at 30 days and 1 year,and may increase the rates of complications of the surgery.
作者
叶国红
关贤颂
戴海鹰
蒋路平
YE Guo-hong GUAN Xian-song DAI Hai-ying JIANG Lu-ping.(Department of Cardiology, Central Hospital of Changsha, Changsha 410007, China)
出处
《中国介入心脏病学杂志》
2016年第10期564-568,共5页
Chinese Journal of Interventional Cardiology
关键词
急性ST段抬高心肌梗死
溶栓
经皮冠状动脉介入治疗
Acute ST-segment elevation myocardial infarction
Fibrinolysis
Percutaneous coronary intervention