序贯再通冠状动脉介入治疗对急性心肌梗死左心室重构的影响

目的 探讨序贯再通的经皮冠状动脉介入（PCI）治疗与传统直接PCI相比对急性S-T段抬高型急性心肌梗死（STEMI）心室重构的影响.方法 对人选的106例STEMI患者随机分为序贯再通PCI组53例和传统的直接PCI组53例.测量对比观察两组患者在介入治疗即刻和之后1个月、3个月、6个月时左心室重构指标[左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室舒张末期内径（LVEDd）、左心室收缩末期内径（LVESd）、左心室重构指数（LVRI）、左心室重量（LVW）和左心室重量指数（LVWI）]的变化.结果 序贯再通PCI组介入治疗后即刻、1个月、3个月、6个月比较,LVESV、LVEDV、LVEDd、LVESd、LVRI的F检验值分别为4.35、2.96、3.11、4.46、2.82,P值分别为0.01、0.03、0.02、0.01、0.04.直接PCI组介入治疗后即刻、1个月、3个月、6个月比较,LVESV、LVEDV、LVEDd、LVESd、LVRI方差分析F值分别为5.1 2、3.1 7、3.21、4.99、3.82,P值分别为0.01、0.02、0.02、0.01、0.03.而LVW和LVWI两组各时间段变化均无统计学意义,F值分别为0.93和1.01,P值分别为0.21和0.12.结果 表明LVESV、LVEDV、LVEDd、LVESd两组在AMI早期就发生重构,1个月时最明显,以后重构变慢,且早期主要发生心腔大小的改变,而LVW改变不显著.两组比较治疗后6个月LVESV、LVESd差异有统计学意义（t=2.59,P=0.01;t=2.43,P=0.02）,其他各项指标差异无统计学意义（P＞0.05）.序贯再通PCI治疗方法对左心室重构影响的OR（odds ratio）值为0.323,95%CI为0.114～0.914,P=0.03.多变量Logistic回归分析结果显示,影响左心室重构的其他因素还有：发病到血流开始再通的时间（OR=4.96,95%CI为1.21～12.74,P=0.01）;梗死面积导联数（OR=3.67,95%C/为1.24～11.28,P=0.02）、人院时心功能Killip级别（OR=3.23,95%CI为1.32～9.71,P=0.02）和年龄（OR=2.66,95%CI为1.25～7.12,P=0.04）.结论 序贯再通PCI治疗在防止LVESd和LVESV的扩大方面优于传统的直接PCI.

Effects of sequel recanalizational intervention on left ventricular remodeling of the patients with acute myocardial infarction

Objective To investigate the effects of sequel recanalization PCI therapy（ percutaneous coronary intervention,PCI）on myocardial remodeling for the patients with acute ST segment elevation myocardial infarction（STEMI）,compared with conventional PCI.Methods One hundred and six patients with STEMI enrolled were divided randomly into two groups：sequel recanalization PCI group（53 cases）and conventional PCI group（53 cases）,to observe the indexes of their cardiac structure（LVESV,LVEDV,LVEDd,LVESV,LVRI,LVW and LVWI）at once and at 1,3,6 month after PCI procedure,respectively.Results In sequel recanalization PCI groups,there were significant differences in the indexes of LVESV,LVEDV,LVEDd,LVESd,LVRI（F value was 4.35,2.96,3.11,4.46,2.82,P value was 0.01,0.03,0.02,0.01 and 0.04 respectively）at 0,1,3 and 6 month,respectively.And in conventional PCI groups there were significant differences in the indexes of LVESV,LVEDV,LVEDd,LVESd,LVRI（F value was 5.12,3.17,3.21,4.99,3.82,P value was 0.01,0.02,0.02,0.01 and 0.03 respectively）.Howewor,between two groups there were no significant differences in the indexes of LVW and LVWI（P0.05）.Compared two groups,there were significant differences only in LVESV（P=0.03）,LVESV（P=0.00）; If sequel recanalization PCI served as a variable for affecting LVR（ increased volune of LVEDV20%）,the results of Logistic regression analysis showed that OR（odds ratio）value was 0.323,95% CI（confidence interval）0.114-0.914,P=0.03.Among other variables,as was time-to-recanalization（OR=4.96,95% CI 1.21-12.74,P=0.01）; infarct size（infarct-related leads）（OR=3.67,95% CI 1.24-11.28,P=0.02）; Kiliip grades（OR=3.23,95% CI 1.32-9.71,P=0.02）and age（OR=2.66,95% CI 1.25-7.12,P=0.04）.Conclusions The sequel recanalization PCI may be better than conventional PCI for the patients with STEMI in inhibiting left ventricular remodeling after acute myocardial infarction.