急诊PCI对高危急性心肌梗死近期病死率的影响

目的：明确急诊经应穿刺冠状动脉介入治疗（PCI）对高危急性心肌梗死（AMI）近期病死率的影响。方法：637例经临床确诊的ST段上抬型、发病时间〈12h的AMI患者被分为急诊PCI（105例）、溶栓治疗（94例）、药物治疗（348例）三组，依据logistic回归方程高危AMI患者的P值，各组更分为高危、低危两个亚组。以Timi血流分级判断急诊PCI梗死相关冠状动脉（IRA）开通、血栓、慢复流、无复流情况；记录住院期间临床事件；4周后用二维超声心动图测定左心室射血分数（LVEF）；统计各组及亚组28天病死率。结果：PCI级IRA开通率为100％，支架率为99．0％。高危与低危两个亚组术中冠脉内血栓发生率分别为25．0％和20．0％；慢复流发生率分别30．0％和25.0％；无复流发生率分别4．0％和o．0％。临床事件中，三组及亚组间出血发生率无显著性差异（P〉0．05）；药物组及其亚组心衰发生率显著高于PCI组和溶栓组及亚组（P均〈0.01）；溶栓组及亚组心绞痛和再梗死发生率较PCI组和药物纽及亚组高（P〈0.05或P〈0．01）；PCI组及其亚组住院天数明显短缩（P〈0．01）；药物组及其亚组LVEF较PCI组和溶栓组及亚组下降（P均〈0.05）；PCI组、溶栓组和药物组的28天病死率分别为0％、7.4％和18．7％（P〈0．05或P〈0.01），且死亡者均为高危亚组患者，溶栓组和药物组的高危亚组痛死率分别为10．4％和26．0％（P〈0．05或P〈0．01）。结论：急诊PCI较尿激酶静脉溶栓及单纯药物治疗AMI更能充分开通IRA，改善心功能，减少临床事件，短缩住院天数；可进一步降低高危AMI病死率。

Inflence on 28-day mortality for higher risk acute myocardial infarction by primary PCI.

Objective:To determine the Influence on 28-day Mortality for high risk acute myocardial infarction by primary PCI.Methods:637 patients with ST segment elevation AMI and less than 12 hours onset,were divided into three groups:primary PCI group,thrombolytic group and medical group.Based on P value of Multivariate logistic regression analysis for higher risk AMI,three groups were divided into subgroups of higher risk and lower risk.Primary PCI groups received acute coronary angiography,open,thrombolysis,slow reflow and no-reflow of IRA were evaluated by Timi flow grade;Clinic events in hospital were recorded;LVEF was measured with two-dimensional echocardiography after 4 weeks onset.Results:The open rate is 100% in primary PCI group and 99.0% stent in its.The coronary thrombolysis rate in operation are 25.0% and 20.0% in higher risk subgroup and lower risk subgroup respectively (P>0.05),and the slow reflow rate are 25.0% and 30.0% respectively (P>0.05).The no-reflow rate are 4.0% and 0.0% respectively (P>0.05).The clinical events including hemorrhage frequency:there were no difference in statistics among three groups and subgroups;heart failure frequency belongine to medical group and subgroup were higher than another two groups and subgroups (P all<0.01);Angina pectoris frequency and reocclusion frequency belonging to thrombolytic group and subgroup were higher than another two groups and subgroups (P<0.05 or P<0.01).The days in hospital obviously reduced in primary PCI group and subgroup (P all<0.01).LVEF of medical group and subgroup were lower than another two groups and subgroups(P all<0.05).The mortality are 0%,7.4% and 18.7% for three groups(P<0.05 or P<0.01);Mortality for three higher risk subgroup are 0%,10.4%,26.0% respectively (P<0.05 or P<0.01).Conclusions:Primary PCI in AMI could improve the reperfusion of IRA and ventricular function,decrease heart events in hospital,shorten time in hospital as well as decrease the mortality of higher risk AMI comparing with single intravenous UK thrombolytic and medical therapy.