缺血预适应在急性心肌梗死溶栓和PTCA中心肌保护作用的对比研究

目的　对比研究心梗前心绞痛在急性心肌梗死患者行急诊溶栓及PTCA中的保护作用。方法　 117例急性心梗患者 ,组 1(6 2例 )行急诊溶栓治疗 ,组 2 (5 5例 )行急诊PTCA和支架置入术 ,各组根据急性心肌梗死前 2 4h内有无心绞痛发作再分两个亚组 ,各组临床基本情况类似。结果　在组 1,心梗前有无心绞痛发作其病死率、泵衰竭、左室射血分数及心肌酶峰值差异均有显著性意义 (P <0 0 5 )。在组 2 ,心梗前有无心绞痛发作其死亡率、泵衰竭、左室射血分数及心肌酶峰值差异无显著性意义 (P >0 0 5 )。结论　心肌梗死前心绞痛是溶栓患者发生死亡及泵衰竭的独立因素 ;对于直接PTCA和支架置入患者其保护作用不显著 ,可能是因为PTCA和支架置入使冠脉充分有效开通的强大保护作用所致

Comparison of protective effects of preinfarction angina pectoris in acute myocardial infarction treated by thrombolysis versus by primary coronary angioglasty with stenting

Objective Comparison of protective effects of preinfarction angina pectoris in patients with acute myocardial infarction between thrombolysis and primary coronary angioplasth with stenting.Methods We studied 117 patients with AMI.Group 1( n =62)was treated with coronary thrombolysis and group 2 with PTCA support stenting.Each group was divided into 2 subgroups: patients with or without preinfarction angina.Results In group 1,there were differences between patients with preinfarction angina and those without in in hospital mortality,pump failure,left ventricular ejection fraction(LVEF),and peak creatine kinase( P <0 05).In group 2,however,it was similar between patients with preinfarction angina and those whthout in in hospital mortality,pump failure,left ventricular ejection fraction(LVEF),and peak creatine kinase( P >0 05).)Conclusion Preinfarction angina is an independent factor of in hospital death and pump failure in group 1,but not in group 2.The protective effect of preinfarction angina in AMI are not evident in those treated by PTCA and stenting,possibly because of the overwhelming protective effects of complete coronary revascularization provided by primary PTCA and stenting.