重组组织型纤溶酶原激活剂与直接冠状动脉内支架术治疗心肌梗死的疗效比较

目的　比较小剂量重组组织型纤溶酶原激活剂 (rt PA)与直接冠状动脉 (冠脉 )支架术治疗急性心肌梗死 (AMI)的临床疗效。方法　 131例患者接受小剂量rt PA 5 0mg静脉溶栓治疗 (溶栓组 ) ,130例患者接受梗死相关动脉 (IRA)直接冠脉支架术 (支架组 ) ,比较两组之间患者的临床治疗效果。结果　小剂量rt PA溶栓治疗组IRA再通率为 81 7%,直接冠脉支架组再通率为 98 5 %,两组差异有显著性 (P <0 0 0 0 0 1)。溶栓组再发心肌梗死、需要择期冠脉支架术明显高于支架组 (分别为7 6 %比 1 5 %,P <0 0 5 ;2 0 6 %比 0 ,P <0 0 0 0 1)。溶栓组住院期间左心室射血分数明显低于支架组[(5 5 6± 13 4 ) %比 (6 5 8± 9 2 ) %,P <0 0 0 0 1]。溶栓组平均住院天数也明显多于支架组 (16± 7比11± 4,P <0 0 0 0 1)。溶栓组住院病死率高于支架组 ,但差异无显著性 (6 1%比 3 1%,P >0 0 5 )。结论　与小剂量rt PA静脉溶栓比较 ,直接冠脉支架术可明显增加IRA的再通率 ,更好地保护心功能 ,并缩短患者的住院时间。

Comparison of the clinical efficacy of recombinant tissue-type plasminogen activator thrombolysis with primary coronary stenting in acute myocardial infarction

OBJECTIVE: To compare the efficacy of low dose recombinant tissue-type plasminogen activator (rt-PA) thrombolysis with primary coronary stenting after acute myocardial infarction (AMI). METHODS: Of 261 patients with first AMI, 131 patients were performed with low dose rt-PA intravenously, and 130 patients with primary coronary stenting. The clinical efficacy of these two groups was compared. RESULTS: The age, time from onset of chest pain to hospital presentation and infarct location between these two groups were comparable. The patency rate of infarct-related artery (IRA) in patients with thrombolysis group was significantly lower than that of patients with primary stenting group (P < 0.00001). The recurrent myocardial infarction, selective coronary stenting of patients with thrombolytic therapy were higher than that of patients with primary stenting group (7.6% vs 1.5%, P < 0.05; 20.6% vs 0, P < 0.001, respectively). The LVEF in patients with thrombolysis group was lower than that of stenting group [(55.6 +/- 13.4)% vs (65.8 +/- 9.2)%, P < 0.0001]. Total hospitalization time of thrombolysis group was longer than that of stenting group [(16 +/- 7) days vs (11 +/- 4) days, P < 0.0001]. The mortality of thrombolysis group was higher than that of stenting group, but this difference was not significant (6.1% vs 3.1%, P > 0.05). CONCLUSIONS: Compared with low dose rt-PA thrombolytic therapy after AMI, primary coronary stenting has a higher patency rate of the IRA, better cardiac function and shorter hospitalization time.