延迟经皮冠状动脉形成术及支架植入对老年急性心肌梗死患者的影响

目的探讨延迟经皮冠状动脉成形术(PTCA)及支架植入对有无梗死前心绞痛老年急性心肌梗死(AMI)患者心肌灌注和预后的近期影响.方法46例老年首次急性心肌梗死患者,按心肌梗死前有无心绞痛史分为无心绞痛组(17例)、有心绞痛组(29例),所有患者均在急性心肌梗死后15～30d行延迟PTCA及支架植入治疗.术前和术后6个月行心肌灌注断层显像(SPET)测定梗死区缺血程度;监测心肌酶谱变化;观察心律失常、心力衰竭、心源性休克发生率和再梗死率.结果有心绞痛组肌酸激酶MB同工酶(CK-MB)峰值低于无心绞痛组,有心绞痛组心肌缺损程度小于无心绞痛组,差异均有显著性(P＜0.05),急性心肌梗死延迟PTCA及支架植入6个月后观察,两组梗死区缺血程度均较术前有改善,有心绞痛组梗死区缺血程度较术前改善尤明显,差异有非常显著性(P＜0.01).有心绞痛组心律失常、心力衰竭、心源性休克和再梗死率有低于无心绞痛组的趋势(P＞0.05).结论心肌梗死前心绞痛对老年急性心肌梗死患者有心肌保护作用,而延迟PTCA及支架植入可明显提高有梗死前心绞痛老年急性心肌梗死患者的心肌灌注,并改善其近期预后.

Effects of Delayed PTCA and Stent on Myocardial Perfusion and Prognosis in Elderly Patients with or without Preinfarction Angina Pertoris

Objective To evaluate short-time effects of delayed PTCA and stent on myocardial perfusion and prognosis in elderly patients with or without preinfarction angina pertoris.Methods Forty-six ederly patients with first acute myocardial infraction(AMI)were divided into non-preinfarction angina group(A group,n=17)and preinfarction angina group(B group,n=29).All patients underwent delayed PTCA and coronary artery stents 15-30d after AMI.The first 99Tcm-MIBI was performed 1-3d before PTCA stent and followed by the second(6 months after) 99Tcm-MIBI.Myocardial enzymes were measured.The incindence of arrhythmia;heart failure,cardiogenic shock and renfarction was observed.Results The peak creatine kinase MB fraction was lower in group B than that in group A(P<0.05).Myocardial infraction area(MIA)was less in group B than that in group A(P<0.05).MIA was significantly decreased in group B 6 months after AMI compared with group A(P<0.01).There was a trend of lower incidence of arrithmias,heart failure,cardiogenic shock and reinfarction in group B compared with that in group A(P>0.05).Conclusion Preinfarction angina has cardioprotective effect in ederly patients and delayed PTCA and stent can significantly improve the myocardial perfusion and short-time prognosis in ederly AMI patients with preinfarction angina.