急性心肌梗死经转运行直接冠状动脉介入治疗的安全性及临床疗效

目的 探讨急性心肌梗死(AMI)后不同时间转运行直接急诊经皮冠状动脉介入治疗(PCI)的安全性和临床疗效.方法 因ST段抬高性的AMI收住外院,并转运至我院行急诊直接PCI的患者,按照发病至开始转诊的时间分为早期转运组(<6 h)、延迟转运组(6～24 h)和晚期转运组(24 h～1周).观察各组转运安全性、急诊PCI术成功率和1个月随访期间左室功能及临床疗效.结果 83例AMI经急诊转入我院接受PCI患者中,早期转运26例,延迟转运39例,晚期转运18例.转运过程中除早期转运和延迟转运组各有2例(分别占7.7%和5.1%)发生心绞痛症状外,各组均无死亡、心力衰竭、心原性休克、室性心动过速和心室颤动等严重心脏事件发生.所有患者均接受了急诊直接PCI术,各组开始转运至球囊扩张时间均在180 min左右.早期转运组PCI成功率为92.3%,延迟转运组为89.7%,晚期转运组为94.4%,各组间比较差异无统计学意义.PCI术后1个月内随访,早期转运组无心脏事件发生;延迟转运组4例(10.3%)发生失代偿性心力衰竭,其中1例(2.6%)在1个月内因心力衰竭死亡;晚期转运组3例(16.7%)发生失代偿心力衰竭,治疗好转出院.3～4周超声心动图示早期转运组左室射血分数为53.2%±9.7%,明显高于延迟转运(48.6%±8.2%,P<0.05)和晚期转运组(43.1%±10.3%,P<0.01).结论 AMI后不同时间对经选择的患者采取转运直接PCI是安全的,且早期转运PCI的疗效明显优于延迟或晚期转运的患者.

The safety and outcome of patients with acute myocardial infarction transferred for primary angioplasty

Objective To evaluate the safety and outcome of patients with acute myocardial infarction (AMI) transferred for primary percutanous coronary intervention (PCI).Methods Data from patients with ST elevation AMI urgently transferred from first admitted hospitals to our catll-lab to receive primary PCI were analyzed.According to time intervals from symptom onset to transfer.the patients were divided into early transfer(<6 h,n=26),delayed transfer (6-24h,n=39) and late transfer (24 h to 1 week,n=18) group.The major cardiac events during transfer periods and one month after PCI were obtained and echocardiogram and left ventficular systolic functions were compared among groups.Results There was no serious cardiac event during transfer period and all 83 patients received primary PCI with a mean transfer-to-balloon time about 180 minutes.Success rate of PCI was 92.3% in early transfer group.89.7% in delayed transfer group,and 94.4% in late transfer group (P>0.05).At one month follow-up after PCI.0.10.3%and 16.7% of patients developed heart failure in early,delayed transfer and late transfer group respectively (P>0.05 vs.early),the LVEF of early transfer group (53.2%±9.7%) was also significantly higher than delayed transfer group (48.6%±8.2%,P<0.05) and late transfer group (43.1%±10.3%,P<0.01).Conclusions Transfer patients with AMI for primary PCI iS safe in the observed time intervals during acute phase.Early transferred patients are associated with better outcome at 1 month post PCI compared to delayed and late transferred AMI patients.