直接经皮冠状动脉介入治疗对急性心肌梗塞后左室重构的影响

目的:研究直接经皮冠状动脉介入治疗(直接PCI)及常规药物治疗对急性心肌梗塞(AMI)后左室重构的影响。方法:应用超声心动图对65例AMI患者进行随访。结果:12~24个月随访显示:直接PCI组患者的心功能分级、再次住院数及死亡数较常规治疗组显著降低(P<0.05)。左室收缩末容积(LVESV)较常规治疗组减小(P<0.01),但左室射血分数(LVEF)增高(P<0.01),球形指数(SI)显著增加(P<0.01),室壁运动指数(WMI)显著降低(P<0.05),左室质量指数(LVMI)也显著降低(P<0.01)。AMI后1个月及12~24个月随访显示:常规治疗组AMI患者12~24个月时LVESV、LVEF及SI较1个月时显著改变(P<0.01),但WMI及LVMI无显著差异(P>0.05)。直接PCI组AMI患者除WMI在12~24个月时较1个月时显著降低(P<0.01)外,余指标均无显著差异(P>0.05)。结论:直接PCI治疗能够明显改善AMI后患者的左室重构,使AMI后心衰、再次住院及死亡发生率降低。

The Effects of Direct Percutaneous Coronary Intervention on Left Ventricular Remodeling after Acute Myocardial Infarction

Objective:To investigate the effects of direct percutaneous coronary intervention(PCI)and routine medical therapy on left ventricular remodeling after acute myocardial infarction(AMI).Mothods:A total of 65 patients were investigated by echocardiography at the first-month and 1-2 year after AMI.Results:There were significant decreased in grade of NYHA and re-hospitalization and mortality rate(P<0.05)in patients received direct PCI compared with patients received routine medical therapy.Left ventricular end-systolic volume(LVESV)and wall motion index(WMI)significantly decreased(P<0.01),and left ventricular ejection fraction(LVEF)and spherical index(SI)increased(P<0.01).There was significant difference in LVESV and LVEF and SI in patients received routine medical therapy(P<0.01),however,not so in patients received direct PCI(P>0.05)between the first month and 1-2 year after AMI.Conclusions:Direct PCI can attenuate left ventricular remodeling after AMI.