急诊PCI靶血管注射小剂量替罗非班和尿激酶对血流和近期预后的影响

目的 分析急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中选择性靶血管内注射小剂量替罗非班和尿激酶对梗死相关血管冠脉血流(TIMI)和近期预后的影响.方法 选择我院2012年1月至2014年10月行STEMI急诊PCI术患者125例,根据PCI术中是否选择性靶冠脉内注射小剂量替罗非班和尿激酶分为A组(非注药组,60例)和B组(注药组,65例).比较两组患者PCI术后梗死相关血管的TIMI分级、出血并发症发生率、1个月时左室射血分数(LVEF)和6个月时主要心血管事件发生率(MACE).结果 B组患者PCI术后TIMI 3级血流获得率明显高于A组(96.9%vs 90.6%),差异有统计学意义(P<0.05);术后1个月B组患者LVEF高于A组[(56.3±8.6)vs(51.2±8.7)],差异有统计学意义(P<0.01);6个月后MACE低于A组(3.1%vs 8.3%),差异有统计学意义(P<0.05);轻中度出血并发症发生率高于A组(9.2%vs 8.4%),但差异无统计学意义(P>0.05).结论 STEMI急诊介入治疗中选择性靶血管内注射小剂量替罗非班和尿激酶明显改善PCI术后的冠脉血流、LVEF及近期临床预后.     

溶栓后即刻经皮冠状动脉介入治疗对发病3 h内急性ST段抬高型心肌梗死预后的影响

目的探讨溶栓后即刻经皮冠状动脉介入治疗(PCI)对发病3h内急性ST段抬高型心肌梗死(STEMI)的安全性和疗效,并与直接PCI策略进行比较。方法连续135例接受PCI的发病3h内STEMI患者,随机分为尿激酶150万U溶栓后即刻PCI和直接PCI两组,记录术前梗死相关动脉(IRA)狭窄程度和术后心肌梗死溶栓试验(TIMI)血流分级、出血并发症及90d随访期间终点事件(死亡、再梗死、再次血运重建、休克及急性左侧心力衰竭)发生率。结果即刻PCI组与直接PCI组相比,出血发生率的差异无统计学意义(7.5%比7.4%,P>0.05),但术前IRA开通率显著升高(50.7%比19.1%,P<0.01),术中慢血流发生率显著降低(13.4%比27.9%,P<0.05),90d复合终点事件发生率呈减低趋势(6.0%比13.2%,P=0.06)。结论发病3h内溶栓后即刻PCI不增加出血并发症,90d预后可能优于直接PCI。     

急性ST段抬高心肌梗死合并非梗死相关动脉慢性完全闭塞直接PCI预后观察

目的分析急性ST段抬高心肌梗死（STEMI）合并非梗死相关动脉（non-IRA）慢性完全闭塞（CTO）患者临床特点和急诊经皮冠状动脉介入治疗（PCI）预后。方法 417例STEMI接受直接PCI患者中,53例至少1支non-IRA为CTO（A组）,另364例无non-IRA CTO（B组）,比较2组病史、介入治疗及其预后。结果 A组陈旧性心肌梗死病史比率（9.4%vs 2.5%,P〈0.05）、2型糖尿病病史比率（26.4%vs 12.9%,P〈0.05）、应用主动脉内球囊反搏（IABP）率（17.0%vs 8.0%,P〈0.05）、临时起搏率（20.8%vs 7.4%,P〈0.01）、心脏电复律率（26.4%vs 7.1%,P〈0.01）均高于B组;随访期间（至少12个月）,A组因心功能不全再次住院率高于B组（28.3%vs 12.9%,P〈0.05）;2组急性期住院期间病死率分别为3.8%和3.6%,随访期间病死率分别为5.7%和5.5%,2组比较差异均无统计学意义（P均〉0.05）。结论 STEMI合并non-IRA CTO患者既往糖尿病、心肌梗死病史多见,病情凶险,借助IABP、心脏电复律、临时起搏治疗多见,但直接PCI仍可明显提高生存率,改善近期、远期预后。     

Frequency of infarct-related artery with myocardial bridging in patients with ST-elevation myocardial infarction and its impact upon percutaneous coronary intervention

Background Myocardial bridging （MB） as a congenital condition with a reported frequency of 5%-12% in diagnostic coronary angiography may be an important factor causing myocardial ischemia. However, its frequency in the infarct-related artery （IRA） of patients with ST-elevation myocardial infarction （STEMI） and the impact upon percutaneous coronary intervention （PCI） remain undetermined. In this study, we investigated MB frequency and its impact upon primary PCI in patients with STEMI. Methods The data of coronary angiography for 554 consecutive patients with STEMI who had undergone successful primary PCI were retrospectively analyzed to identify a frequency of MB in the IRA and its association with gender and age. According to the angiographic findings, the patients were divided into MB patients and non-MB patients. The endpoints of this study included immediate angiographic findings after primary PCI and 6-month major adverse cardiac events （MACE） （death, recurrent myocardial infarction, target lesion or vessel revascularization） between the MB patients and the non-MB patients. Results A frequency of MB in the IRA of 46 patients （8.3%） was identified in this series; it was more common in patients ≥65 years old （36/206） than in those 〈65 years old （10/348） （17.5% vs 2.9%, P〈0.001）. The trend of MB in the IRA was observed more frequently in women without significant difference than in men （10.2% vs 7.8%）. TIMI grade Ⅲ flow was achieved in 91.9% （509/554） of all patients following primary PCI, in 60.9% （28/46） of the MB patients and in 94.7% （481/508） of the non-MB patients respectively （P〈0.001）. The in-hospital mortality was 4.7% （26/554） in this series including 13.0% （6/46） of the MB patients and 3.9% （20/508） of the non-MB patients （P〈0.001）. A significant difference in 6 months MACE was seen between the MB patients （19%） and the non-MB patients （6.2%） （P〈0.001）. Conclusions MB in the IRA is relatively common in elderly patients with STEMI with a more evident trend in women, suggesting that arteriosclerosis and plaque rupture occurs more easily in the proximal artery to MB than in younger patients. Poor TIMI grade flow in patients with MB in the IRA after primary PCI may contribute to a high in-hospital mortality rate （13%） and 6-month MACE （19%） in the MB patients.     

局部肿瘤坏死因子-α与急性心肌梗死急诊冠脉介入术后心肌灌注关系的研究

目的探讨靶血管局部肿瘤坏死因子-α(TNF-α)对急性心肌梗死患者行急诊冠脉介入(primary percutaneous coronary intervention,PPCI)术后心肌灌注的影响。方法行急诊PCI术、并行血栓抽吸术的急性ST段抬高性心肌梗死(STEMI)患者,男性116例,女性32例,平均年龄(59.7±22.8)岁。冠脉造影前,经动脉鞘取血3 mL;PCI术前,采用Export XT血栓抽吸导管在靶血管内抽吸血栓、过滤栓子等成分,分离血清备用。按照常规方法植入支架。主要终点为术后心肌呈色分级,次要终点为ST段回落幅度。血清TNF-α采用ELISA法检测。结果 MBG 0～1级患者局部TNF-α浓度为(340.7±55.4)pg/L,MBG 2级为(207.5±42.1)pg/L,MBG 3级为(137.3±33.2)pg/L,差异有显著性(P=0.00)。ST段回落≥70%患者局部TNF-α浓度为(159.2±52.4)pg/L,ST段回落<70%为(308.6±43.9)pg/L,差异有显著性(P=0.00)。外周动脉血中的TNF-α浓度与MBG分级、ST段是否完全回落没有显著相关(P>0.05)。Logistic回归显示,TNF-α最高四分位区间是心肌灌注不良的唯一预测因子,与最低的四分位区间相比,发生心肌灌注不良的几率增加2.1倍(95%置信区间:1.17～7.81)。结论急性心肌梗死患者中,靶血管局部TNF-α浓度升高与急诊PCI术后心肌灌注不良有关,全身的TNF-α浓度对术后心肌灌注的影响不显著。     

冠状动脉内注射替罗非班治疗急性ST段抬高型心肌梗死的疗效和预后评价

目的分析急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）术中冠状动脉（冠脉）内注射替罗非班对梗死相关血管冠脉血流（TIMI）的影响。方法 116例STEMI患者根据PCI术中是否冠脉内应用替罗非班分为常规治疗组（66例）和替罗非班组（50例）,对比2组PCI术后梗死相关血管的TIMI分级、校正的TIMI计帧数,观察2组患者出血并发症发生率、住院期间和出院后6个月主要心血管事件发生率。结果替罗非班组PCI术后TIMI 3级血流获得率明显高于常规治疗组,差异有统计学意义（98.0%vs 84.8%,P〈0.05）;校正的TIMI计帧数低于常规治疗组,差异有统计学意义〔（21.5±5.9）帧vs（29.6±6.2）帧,P〈0.01〕。术后1周替罗非班组左心室射血分数（LVEF）高于常规治疗组,差异有统计学意义（P〈0.01）;出血并发症发生率高于常规治疗组,但差异无统计学意义（P〉0.05）;6个月内主要心血管事件发生率低于对照组,差异有统计学意义（P〈0.05）。结论 STEMI介入治疗中冠脉内注射替罗非班较为安全,可以明显改善PCI术后的冠脉血流、心肌灌注及临床预后。     

首次心肌梗死患者878例冠状动脉病变的特点分析

目的　探讨首次心肌梗死 (MI)后冠状动脉病变的特点。方法　对 1998年 5月至 2 0 0 0年 12月间在中国协和医科大学阜外心血管病医院完成择期冠状动脉造影 (≤ 6个月 )的首次MI连续病例 878例的造影结果进行分析。其中前、侧壁MI 4 81例 ,下、后壁MI 36 8例 ,后、侧壁MI 19例 ,不详者 10例。曾予溶栓治疗者 394例 ,明确成功 176例 ( 4 4 7% ) ;MI前、后有心绞痛发作者分别占 5 9 8%和 4 8 7%。结果　 ( 1) 878例中 ,单支、双支和 3支或 4支 (合并中间动脉 )病变者分别占 32 8%、2 6 4 %和 34 9% ,无明显狭窄或正常者仅占 5 9% ,合并左主干病变者占 3 2 %。MI前有心绞痛史者≥ 3支病变者的比例明显高于无心绞痛史者 ( 39 2 %比 2 8 3% ,P <0 0 1) ,而溶栓者明显低于未溶栓者 ( 30 5 %比 38 4 % ,P <0 0 5 )。 ( 2 )推测梗死相关动脉 (IRA)的狭窄程度为 10 0 %闭塞、95 %～ 99%次全闭塞、70 %～ 94 %严重狭窄、5 0 %～ 6 9%临界狭窄者分别占 2 9 6 %、2 2 6 %、37 9%和 4 9% ,而 <5 0 %者仅占 5 1% ;溶栓治疗组完全闭塞者比例比未溶栓或不详组低 ,差异有显著意义 ( 2 4 6 %比33 7% ,P <0 0 1)。 ( 3) 878例患者中至少有 1处主要冠状动脉病变狭窄≥ 70 %、≥ 90 %、≥ 95 %和10 0 %闭塞者分别占     

曲美他嗪对直接经皮冠状动脉介入治疗后ST段回落不良的心肌梗死患者预后的影响

目的 前瞻性评价曲美他嗪对直接经皮冠状动脉介入(PCI)治疗后ST段回落不良的心肌梗死患者临床预后的影响.方法 2005年8月至2007年10月共入选138例直接PCI治疗后ST段回落不良的急性ST段抬高的前壁心肌梗死患者,分为曲美他嗪治疗组(70例)和对照组(68例).治疗组在术后1h顿服60 mg曲美他嗪,继之以20 mg,3次/d,口服1周.对照组不应用曲美他嗪.比较两组的基线临床状况,出院后30 d、6个月的主要心脏不良事件(MACE,包括死亡,再梗死,再次靶血管重建)发生率和左室射血分数(LVEF).结果 两组的基线临床资料差异无统计学意义.两组出院后30d和6个月的MACE发生率差异亦无统计学意义,分别为14.3 %比16.2 %, (P>0.05); 21.4 %比 19.1%, (P>0.05).治疗组30d和6个月的LVEF显著高于对照组分别为(51±8)%比(45±7)%;(56±7)%比( 49±8)%, (均P<0.01).结论 曲美他嗪对直接PCI后ST段回落不良的急性ST段抬高心肌梗死患者的30d和6个月的MACE无影响,但是可以改善其30 d和6个月的心功能.     

尿激酶溶栓后即刻PCI与直接PCI治疗STEMI的比较

目的:比较溶栓后即刻经皮冠状动脉介入治疗(即刻PCI)与直接PCI治疗急性ST段抬高心肌梗死(STEMI)的安全性和疗效。方法:分析接受PCI治疗的连续130例STEMI患者冠脉病变及干预情况,随机分为尿激酶150万单位溶栓后即刻PCI和直接PCI两组,记录术中慢血流无血流、出血并发症、平均住院日、院内死亡率及平均18.1个月随访期间终点事件发生率。结果:两组临床特征及冠状动脉病变相似(P>0.05),即刻PCI组与直接PCI组相比,就诊-球囊时间、术中无血流慢血流、PCI成功率、出血并发症、平均住院日、院内死亡率以及18.1个月心血管事件发生事均无显著差异(P均>0.05)。结论:即刻PCI不增加出血并发症,但近期疗效和远期预后并未发现优于直接PCI。     

Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation

Background Prognosis of patients with acute ST-elevation myocardial infarction （STEMI） and renal dysfunction （RD） who received primary percutaneous coronary intervention （PCI） has not been fully investigated in the drug-eluting stent （DES） era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI.
Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission （RD group）, and the remaining 533 patients had normal renal function （non-RD group）. The primary endpoint was 30-day major adverse cardiac events （MACE, including death, non-fatal reinfarction, and target vessel revascularization）, and the secondary endpoint was subacute stent thrombosis.
Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 （29.1% vs 18.6%, P=0.02） and multi-vessel （62.8% vs 44.5%, P=0.001） and triple vessel disease （32.6% vs 18.2%, P=0.002）, in-hospital mortality （9.3% vs 3.8%, P=0.03）, and MACE rate during hospitalization （17.4% vs 7.7%, P=-0.006） were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group （76.7% vs 89.9%, P=-0.0003）. Angiographic stent thrombosis occurred in 3 （3.5%） and 7 （1.3%） of patients in the RD group and non-RD group, respectively （P=0.15）. Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up （Hazard ratio （HR） 3.31,95% CI 1.19-9.18, P 〈0.001）.
Conclusion Despite similar prevalence of stent thromb     

Long-term effects of drug-eluting stents versus bare metal stents on patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: outcomes of 3-year clinical follow-up

Background  The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation.  

Methods  A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n=83) or BMS (n=108) implantation in the infarction related artery according to physician’s discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups.

Results  The clinical follow-up duration was 3 years ((41.7±16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P=0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P=0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P=0.379) and stent thrombosis (1.20% vs. 1.85%, P=0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P=0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P=0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n=73) and paclitaxel-eluting stents (PES, n=10) subgroups (2.74% vs. 20.00%, P >0.05).

Conclusions  This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.     

不同血运重建方式治疗复杂冠状动脉病变合并左心功能不全的围术期疗效比较

目的对比研究冠状动脉旁路移植术（CABG）和经皮冠状动脉介入术（PCI）治疗复杂冠状动脉病变合并左心功能不全 （LVD）的围术期疗效。方法回顾性分析2003年1月~2013年12月在我院接受CABG和PCI治疗的复杂冠脉病变合并左心功 能不全（左室射血分数LVEF≤50%）患者的临床资料,其中CABG 患者386 例,PCI 患者580 例,采用1∶1 配对方法,以 EuroSCORE危险因素及术前超声心动图指标为配对标准,两组各纳入患者135例,比较两组患者近期结果及术前术后左室形态 及功能变化。结果两组患者基线资料比较,PCI组慢性肺病及3个月内心梗发生率显著高于CABG组（8.1% vs 0.7%,P=0.003; 64.4% vs 31.9%,P=0.000）,而左主干病变比例显著低于CABG组（12.6% vs 23.7%,P=0.018）,其它方面两组之间无统计学差 异。血运重建结果比较：CABG组处理的靶血管数目明显多于PCI组（2.90±0.81 vs 1.67±0.73,P=0.000）,完全再血管化程度明 显高于PCI 组（94.8% vs 51.8%,P=0.000）。术后术前超声结果比较：CABG组与PCI 组LVEF差值无显著差异（P=0.171）,而 CABG组LVEDD差值明显高于PCI组（P=0.000）。围术期不良事件方面,两组住院死亡率及其它严重并发症无统计学差异。 结论对于复杂冠脉病变合并LVD患者,CABG与PCI均为安全可行的血运重建方式。与PCI相比,CABG完全再血管化程度 更高,术后早期左心功能改善更为明显。     

Gender differences in efficacy of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

Background The clinical outcome of percutaneous coronary intervention （PCI） is poorer in women than that in men. This study aimed at comparing the impact of gender difference on the strategy of primary PCI in patients with acute ST-segment elevation myocardial infarction （STEMI）.
Methods Two hundred and fifty-nine patients with STEMI who underwent primary PCI within 12 hours of symptom onset were enrolled. The male group consisted of 143 men aged 〉55 years, and a female group included 116 women without age limitation. Procedural success was defined as residual stenosis 〈20% with thrombolysis in myocardial infarction flow grade 〉2 and without death, emergency bypass surgery or disabling cerebral events during the hospitalization. The rate of major adverse cardiac events （MACE）, including death, nonfatal myocardial infarction and target vessel revascularization during follow-up, was recorded.
Results Female patients were more hypertensive and diabetic and with fewer cigarette smokers than male counterparts. The prevalence of angiographic 3-vessel disease was higher in the female group, but the procedural success rate was comparable between the two groups （94.4% vs 92.2%）. The occurrence rate of MACE did not differ during the hospitalization （4.2% vs 6.0%, P=0.50）, but was significantly higher in the female group during follow-up （mean （16.0±11.2） months） than that in the male group （5.4% vs 0.7%, P=0.02）.
Conclusion Despite a similar success rate of primary PCI and in-hospital outcomes in both genders, female patients with acute STEMI still have a worse prognosis during the long-term follow-up.     

术前强化瑞舒伐他汀钙治疗对急性ST段抬高型心肌梗死患者介入术后的临床观察

目的 探讨早期强化瑞舒伐他汀钙治疗对急性ST段抬高型心肌梗死（STEMI）急诊介入治疗（PCI）预后的影响.方法 2012年6月-2013年6月,在我院接受急诊介入治疗的急性ST段抬高型心肌梗死患者85例,随机分为强化组和对照组.强化组在术前30 min内开始口服瑞舒伐他汀钙20 mg,以后20 mg/d,连服7d,之后10 mg/d维持.对照组在术前不服用他汀类药物,仅术后以10 mg/d瑞舒伐他汀钙维持.比较两组治疗后的冠脉即刻血流、血肌钙蛋白I（TNI）、磷酸肌酸激酶同工酶（CK-MB）、高敏C反应蛋白（hs-CRP）、氮末端-前体脑钠肽水平（NT-proBNP）以及超声心动图的情况.结果 强化组中无复流和慢血流发生率分别为8.9％和17.8％,低于对照组的15％和27.5％,CK-MB122.9±15 u/L、TNI3.81±1.8、NT-proBNP 2645 ±534 pg/L、hs-CRP 4.31±1.3均低于对照组的155.8±21 u/L、4.73±2.2、3534±656、5.30±1.6,两组相比有统计学差异（P＜0.05）.而超声心动图中的左室舒张末期容积、左室射血分数、短轴缩短率、左房内径和室间膈厚度两组相比无统计学差异（P＞0.05）.结论 术前强化瑞舒伐他汀钙可减少急性ST段抬高型心肌梗死急诊PCI患者术后即刻血流,减少心肌坏死,改善心室重构.     

急诊经皮冠状动脉介入术对急性心肌梗死患者血浆B型钠尿肽的影响

目的 探讨急诊经皮冠状动脉介入术(PCI)对急性心肌梗死(AMI)患者血浆B型钠尿肽(BNP)的影响。方法 选择2002年6月至2003年12月在我院监护中心住院的38例AMI患者,分成急诊PCI组(A组)26例,非再灌注治疗组(B组)12例。在入院时和入院后第1、7、30天采用荧光免疫法(FIA)分别测血浆BNP浓度,A组只干预相关梗塞血管,B组按一般常规治疗。结果 两组病人在入院和入院后1dBNP水平均升高(A组:243.74±75.68,283.42±88.66;B组:228.65±82.32,275.48±89.67),但两者比较无差异,P>0.05;7d后,A组下降,B组仍维持高水平(203.63±59.42对388.74±108.52,P<0.05);30d后,A组下降明显,B组BNP亦有下降,但比较仍有非常显著差异(96.31±43.22对237.66±75.48,P<0.01);急诊PCI干预不同梗死相关血管(IRA)时,血浆BNP变化亦不同,干预前降支较右冠脉和回旋支BNP下降更明显。LVEF和LVEDD的变化和BNP的变化相对应。3例死亡病例血浆BNP水平均高于正常10倍以上。结论 AMI患者经急诊PCI再灌注治疗后血浆BNP在7d开始下降,30d下降更为显著。     

急性心肌梗死伴心衰、心源性休克病人经皮冠状动脉介入治疗近中期疗效

目的 观察ST段抬高急性心肌梗死(AMI)伴心衰、心源性休克患者经皮冠状动脉介入治疗(PCI)的近期、中期疗效。方法 总结分析206例ST抬高AMI患者的临床资料,其中伴心衰和/或休克90例。对心衰或/和心源性休克患者行PCI58例(PCI组:急诊PCI41例,外院转入行补救性PCI17例),药物溶栓20例(溶栓组),一般治疗12例(未行再灌注组);分析各组患者的临床特征,并比较PCI组及溶栓组的住院时间、住院及随访期间不良心血管事件发生率、心功能恢复情况,观察PCI组血管开通时间、TIMI血流与预后的关系。结果 PCI组、溶栓组血管开通率分别为98.3%和65.0%(P<0.01),平均住院时间分别为(15.3±3.5)d和(20.5±4.4)d,住院及随访期间死亡率PCI组6.9%,溶栓组25%(P<0.05)。PCI组两亚组术后心功能恢复均好于溶栓组(P<0.01和P<0.05)。结论 对于ST段抬高AMI伴心衰、心源性休克患者,PCI与溶栓相比,能及时开通血管且开通率高,术后近期及中期心功能恢复较好,不良心血管事件少,是一种安全有效的治疗措施,可作为首选。     

急性心肌梗死伴心衰、心源性休克病人经皮冠状动脉介入治疗近中期疗效

OBJECTIVE: To observe the short- and mid-term effects of percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute myocardial infarction (AMI) complicated by heart failure and/or cardiogenic shock . METHODS: Altogether 90 patients with AMI were recruited, of whom 58 were treated by PCI, 20 by thrombolytic therapy, and the other received general treatment without reperfusion therapy. The length of hospital stay, major adverse cardiac events (MACE) and left ventricular ejection fraction (LVEF) were compared between PCI and thrombolysis groups. The relationship between the patency time of the infarct-related artery (IRA), thrombolysis in myocardial infarction (TIMI) grade after PCI and prognosis were analyzed in PCI group. RESULTS: The patency rate of IRA was significantly improved in patients receiving PCI therapy in comparison by those with thrombolytic therapy (98.3% vs 65.0%, P<0.01), and the LVEF was also higher in PCI group with lower mortality (6.9% vs 25.0%, P<0.05) during in-hospital and follow-up period. CONCLUSION: PCI can be a more effective therapy than thrombolytic therapy in the treatment of ST-segment elevation AMI accompanied with heart failure and/or cardiogenic shock.     

不同途径介入治疗急性心肌梗死的对照研究

目的:比较不同途径急诊经皮冠状动脉介入治疗(PCI)对ST段抬高的急性心肌梗死的安全性和有效性.方法:收集254例发病≤12 h 的ST段抬高的急性心肌梗死患者的临床资料,比较经桡动脉急诊PCI(TRA组,n=182)与经股动脉急诊PCI(TFA组,n=72)患者的手术操作、住院情况以及随访期主要不良心脏事件(MACE)发生率.结果:两组穿刺成功率、穿刺至首次球囊扩张时间、手术成功率、住院和随访期间MACE发生率差异均无统计学意义(P>0.05).TRA组手术时间短[(36.1±16.3)min vs (40.5±15.1)min,P=0.049),依从性高(81.9% vs 26.4%,P＜0.005),血管并发症明显减少(5.5% vs 34.7%,P＜0.005),住院时间缩短[(9.2±3.0)d vs (10.8±4.2)d,P=0.003].结论:在强化抗栓条件下,相对于股动脉途径,急诊经桡动脉PCI有相似的有效性及安全性,且并发症和住院日更少.     

缺血预适应对老年急性心肌梗死患者经皮冠状动脉介入治疗预后的影响

目的 研究缺血预适应(IP)对接受经皮冠状动脉介入治疗(PCI)的不同年龄急性心肌梗死(AMI)患者保护作用的异同.方法 回顾性分析2006年3月至2010年3月190例首次发生AMI患者的临床资料.所有患者在发病12h内进行PCI,按年龄分为老年组(≥60岁,n=105)及成年组(<60岁,n=85),再依据AMI前...     

Intracoronary adenosine improves myocardial perfusion in late reperfused myocardial infarction

Background Myocardial perfusion associates with clinical syndromes and prognosis.Adenosine could improve myocardial perfusion of acute myocardial infarction within 6 hours,but few data are available on late perfusion of myocardial infarction (MI).This study aimed at quantitatively evaluating the value of intracoronary adenosine improving myocardial perfusion in late reperfused MI with myocardial contrast echocardiography(MCE).Methods Twenty-six patients with anterior wall infarcts were divided randomly into 2 groups:adenosine group(n=12) and normal saline group(n=14).Their history of myocardial infarction was about 3-12 weeks.Adenosine or normalsaline was given when the guiding wire crossed the lesion through percutaneous coronary intervention(PCI),then the balloon was dilated and stent(Cypher/Cypher select)was implanted at the lesion.Contrast pulse sequencing MCE with Sonovue contrast via the coronary route was done before PCI and 30 minutes after PCI.Video densitometry and contrast filled-blank area were calculated with the CUSQ off-line software.Heart function and cardiac events were followed up within 30 days.Results Perfusion in the segments of the criminal occlusive coronary artery in the adenosine group was better than that in the saline group(5.71±0.29 vs 4.95±1.22,P＜0.05).Ischemic myocardial segment was deminished significantly afterPCI,but the meliorated area was bigger in the adenosine group than in the saline group((1.56±0.60)cm2 vs(1.02±0.56) cm2,P＜0.05).The video densitometry in critical segments was also improved significantly in the adenosine group (5.53±0.36 vs 5.26±0.35,P＜0.05).Left ventricular ejection fraction(LVEF)was improved in all patients after PCI,but EF was not significant between the two groups((67±6)% vs(62±7)%,P＞0.05).There was no in-hospital or 30-day major adverse cardiac event(MACE)in the adenosine group but 3 MACE in the saline group in 30 days after PCI.Conclusions Adenosine could improve myocardial microvascular perfusion in the late reopening of an occluded infarct reIaled artery(3 to 12 weeks after AMI)and clinical outcome in the follow-up period,and myocardial microvascular perfusion is a powerful predictor of clinical events.