溶栓后早期转运PCI与保守治疗/补救转运PCI治疗STEMI患者的比较

目的：本研究回顾分析比较急性心肌梗塞（AMI）患者在基层医院行溶栓治疗后,早期转运到上级医院行经皮冠状动脉介入治疗（PCI）和继续在当地予保守治疗然后作转运PCI的优劣。方法：315例AMI患者在发病12h内,于基层医院接受溶栓治疗,其后183例直接转诊行PCI（A组）,132例在当地继续保守治疗,67例因再次出现心肌缺血症状行补救性转运PCI（B组）。比较两组1年内全因死亡、再梗死、难治性心肌缺血发生率及30d内严重出血和脑卒中发生率,以及治疗前后左室射血分数（LVEF）改变情况。结果：与B组比较,A组1年内全因死亡率（6.8%比1.6%）、再梗死发生率（17.4%比3.3%）、难治性心肌缺血发生率（22.7%比4.4%）均明显降低（P均〈0.05）,而LVEF改善情况A组明显优于B组（58.7±12.4）%比（47.6±11.9）%,P〈0.05]。结论：溶栓后的ST段抬高性心肌梗死患者应尽早转运到上级医院接受PCI治疗,以取得更好疗效。

Comparison between early transport PCI and conservative therapy/rescue PCI after thrombolysis in STEMI patients

Objective: To compare effects of early transporting to advanced hospital for percutaneous coronary intervention(PCI) and receiving standard conservative therapy rescue transport PCI in patients with acute myocardial infarction(AMI) after thrombolysis in primary hospitals.Methods: A total of 315 patients with ST segment elevation myocardial infarction,received thrombolysis therapy within 12h after chest pain,in which 183 cases transported to advanced hospital for PCI immediately(group A),132 cases continued conservative therapy and 67 cases received rescue transport PCI because of recurrent myocardial ischemia(group B).Clinical cardiovascular events and changes of left ventricular ejection fraction(LVEF) were compared between two groups.Results:Compared with group B,there were significant decrease in all-cause mortality rate(6.8% vs.1.6%),incidence rates of reinfarction(17.4% vs.3.3%) and refractory myocardial ischemia(22.7% vs.4.4%),P<0.05 all,LVEF of group A was significantly better than that of group B(58.7±12.4)% vs.(47.6±11.9)%,]P<0.05 all.Conclusion: Patients with ST segment elevation myocardial infarction after thrombolysis should transport to advanced hospital for immediately PCI to get better effects.