急性心肌梗死患者的直接经皮腔内冠状动脉成形术与溶栓治疗疗效比较

为探讨急性心肌梗死直接经皮腔内冠状动脉成形术的安全性及临床疗效 ,选择 6 2例未经静脉和冠状动脉内溶栓治疗的急性心肌梗死患者 ,在紧急冠状动脉造影后即行直接经皮腔内冠状动脉成形术 ;另外选择 5 9例急性心肌梗死患者 ,采用溶栓治疗 ,溶栓治疗后不再接受介入治疗和外科冠状动脉搭桥 ,然后比较直接经皮腔内冠状动脉成形术和溶栓治疗的疗效、安全性及预后。结果发现 ,直接经皮腔内冠状动脉成形术组 6 0例再灌注成功 ,成功率为 96 .7% ,其中 4例合并心源性休克的患者均再灌注成功 ,血压回升 ,急性上消化道出血 1例 ,死亡率为 0 ;溶栓治疗组 38例再灌注成功 ,成功率为 6 4 .4 % ,住院期间死亡 5例 ,出院 6月内死亡 2例 ,急性上消化道出血 1例 ,血尿 1例 ,溶栓治疗后心源性休克 5例 ,死亡率为 1 1 .9%。直接经皮腔内冠状动脉成形术再灌注成功率明显高于溶栓治疗 ,死亡率和主要心脏事件的发生率明显低于溶栓治疗 (P <0 .0 1 )。结果提示 ,急性心肌梗死的直接经皮腔内冠状动脉成形术治疗安全有效 ,再灌注成功率明显高于溶栓治疗 ,疗效及预后优于溶栓治疗

Comparing the Therapeutic Effects of Direct Percutaneous Transluminal Coronary Angioplasty vs Thrombolytic Therapy for Treatment of Acute Myocardial Infarction

Aim To evaluate the safety and therapeutic effects of direct percutaneous transluminal coronary angioplasty (PTCA) in treatment of acute myocardial infarction (AMI), and compare the effects vs thrombolytic therapy. Methods 62 AMI patients without thrombolytic therapy were treated by direct PTCA after urgent coronary angiography, 59 AMI patients were treated by thrombolytic therapy. The safety and therapeutic effects of direct PTCA were studied and compared with thrombolytic therapy. Results In direct PTCA group, 60 cases were reperfused (96.7%), among which 4 were complicated with cardiogenic shock and the blood pressure raised to normal, 1 case was complicated with acute upper gastrointestinal hemorrhage, no mortality; whereas, in thrombolytic treatment group, 38 cases were reperfused (64.4%), 5 died in hospital and 2 died after discharge; 1 patient complicated with acute upper gastrointestinal hemorrhage, 1 with hematuria and 5 with cardiogenic shock; the motality was 11.9%. The rate of reperfusion in direct PTCA group was higher than that of thrombolytic therapy group; meanwhile, the incidence of major cardiac events in direct PTCA group was significantly lower than that of thrombolytic therapy (P<0.01). Conclusions Direct PTCA for treatment of AMI was safe and effective; the rate of reperfusion after direct PTCA was higher than that of thrombolytic therapy; thus, the therapeutic effects and the prognosis of direct PTCA was better than those of thrombolytic therapy.