rt-PA静脉溶栓与直接冠脉支架术治疗急性心肌梗塞的对比观察

目的 比较rt-PA静脉溶栓与直接冠状动脉支架术治疗急性心肌梗塞(AMI)的近期临床效果.方法 238例AMI患者中,130例行rt-PA静脉溶栓治疗,108例行直接冠状动脉支架置入术,观察30天.结果 溶栓组中梗塞相关动脉(IRA)临床评价再通者102例,再通率78.5%:直接冠脉支架组术后IRA血流达Ⅱ-Ⅲ达100%.随访1个月,溶栓组和直接冠脉支架组病死率分别为4.3%和0.9%P>0.05);再缺血事件发生率分别为18.5%和0.9%(P<0.05);出血并发症发生率分别为14.6%和1.9%(P<0.05);溶栓组的左室射血分数(LVEF)为52.3±8.0,直接支架组为63.3±9.2(P<0.05).结论 直接冠状动脉支架术治疗AMI与rt-PA静脉溶栓治疗相比具有较高的IRA的再通率和良好的近期预后.

Comparison of the short term outcome of primary intracoronary stenting and intravenous recombinant tissue plasminogen activator (rt-PA ) in acute myocardial infarction

Objective To compare the clinical efficacy of primary ientracoronary stenting and intravenous throm-bolytic therapy using rt-PA in patients with acute myocardial infarction (AMI). Methods From 01/97 to 09/99 two hundreds and thrty-eight consecutive patients with AMI underwent either intravenous thrombolytic therapy using rt-PA (130 patients) or primary intracoronary stenting ( 108 patients) . Left ventricular ejection fraction was measured by two-dimensional echocardiography. Cardiac events were recorded during follow-up. Results The re-open rate of infarct related artery (IRA) in patients with thrombolytic therapy using rt-PA was 78. 5% , while in those with primary intracoronary stenting was 100%. At 30-day follow-up, in the patients underwent intracoronaty stenting. the left ventricular ejection fraction was 52. 3±8. 0, the rate of in-hospital death was 0. 9%,the recurrent ischemia rate was 0. 9% . the complication of hemorrhage rate was 14. 6% , and they were 63. 3±9. 2. 4. 3% . 1 8. 5% and 1. 9%, respectively in patients underwent thrombolytic therapy using rt-PA. Conclusion The present study showed that primary intracoronary stenting for patients with AMI was safe and exerted a beneficial effect on the prognosis of patients than the patients with intravenous thrombolytic therapy using rt-PA.