易化经皮冠状动脉介入治疗对急性心肌梗死心室收缩同步性的影响

目的 通过ERNA,对比评价溶栓、经桡动脉直接行PCI和易化PCI 3种治疗方式对AMI患者心室收缩同步性的影响.方法 选择首次AMI(前壁)患者213例,按随机数字表法分为溶栓组70例、直接PCI组71例和易化PCI组72例.3组患者于AMI后1周和28周分别行ERNA,测定左室收缩功能参数LVEF、峰射血率(PER)、峰射血率时间(TPER)]、舒张功能参数峰充盈率(PFR)、峰充盈率时间(TPFR)]及同步性功能参数(PS、FWHM、PSD),随访28周内主要恶性心脏事件的发生率.计量资料组间及自身前后比较行t检验.结果 (1)3组患者一般临床资料无明显差异.(2)首次CAG结果显示,直接PCI组在PCI前CAG所示梗死相关动脉(IRA)开通率(8.45％,6/71)明显低于溶栓组(31.43％,22/70)和易化PCI组(30.56％,22/72),x2=11.69和11.09,P均＜0.01.易化PCI组术后IRA血流TIMI-3级率(98.61％,71/72)高于直接PCI组(88.73％,63/71),x2=4.35,P＜0.05.(3)AMI后随访28周,易化PCI组LVEF和PER为(50.45±6.23)％和(2.68±0.11)EDV/s,直接PCI组为(42.75±3.47)％和(2.18±0.08) EDV/s,t =2.08和2.13,P均＜0.05；TPER、PS、PSD前者分别为(151±16) ms、(41.92±16.75)°和(9.14±1.28)°,后者为(168±15) ms、(46.28±12.33)°和(10.77±4.26)°,t=2.10、2.19和2.45,P均＜0.05.(4)随访28周易化PCI组和直接PCI组恶性心脏事件发生率为8.33％(6/72)和8.45％(6/71),溶栓组为54.29％(38/70),x2=35.05和34.49,P均＜0.001.结论 经桡动脉易化PCI治疗可在早期充分、持久地开通IRA,能在AMI早期阻抑急性左室重构过程,改善左室功能和收缩的同步性,其效应优于直接PCI和单纯溶栓治疗.

The effect of facilitated percutaneous coronary intervention on systolic synchrony performance in patients with acute myocardial infarction

Objective To evaluate the influence of thrombolysis, primary PCI and facilitated PCI via a transradial approach therapy on systolic performance and synchrony in patients with AMI using ERNA. Methods A total of 213 patients with their first anterior AMI were enrolled in this study. Seventy patients were randomized to a thrombolytic treatment group, 71 patients to a primary PCI group and 72 patients to a facilitated PCI group. At 1 week and 28 weeks after AM1 onset, parameters of the LYEF, peak ejection rate （PER）, time to peak ejection rate （TPER）, peak filling rate （PFR）, time to peak filling rate （TPFR） and left ventricular systolic synchrony （LVSS） （ PS, FWHM, PSD） were measured by ERNA with ventricular phase analysis. Major adverse cardiac events （MACE） such as post AMI angina, recurrence of MI or mortality were recorded. The t-test was used to compare the data. Results （ 1 ） There were no significant differences among the three groups in clinical characteristics. （2） The first CAG showed that the grade of the infarct related artery （IRA） in the primary PCI group （8.45%, 6/71 ）was significantly lower than that in the thrombolytic treatment group （31.43% ,22/70） （X^2 = 11.69, P 〈 0.01 ） and also lower than that in the facilitated PCI group （30.56%, 22/72） （X^2 = 11.09, P 〈0.01 ）. The TIMI-3 grade rate of IRA post PCI in the facilitated PCI group （98.61%, 71/72） was higher than that in the primary PCI group （ 88.73% , 63/71 ） ,X^2 = 4. 35, P 〈 0.05. （3） At 28 weeks after AMI, LVEF increased significantly from （42.75 ＋3.47）% to （50.45 ＋6.23）% （t=2.08, P〈0.05） and PER from （2.18 ＋0.08） EDV/sto （2.68 ±0.11） EDV/s （t =2.13, P〈0.05） in the facilitated PCI group, while TPER, PS and PSD decreased signifieantly from （ 168 ± 15） ms to （ 151 ± 16 ） ms, （46.28 ± 12.33 ）° to （41.92 ± 16. 75 ）°, （10.77 ±4.26）°to （9.14 ± 1.28）° respeetively（t =2.10, 2.19, 2.45, all P〈0.05） ,when compared with those in the primary PCI group. （4） The incidence of MACE in the 28 week follow-up in the facilitated PCI group（8.33% ,6/72; X^2 =35.05, P〈0.001） and primary PC1 group （8.45% ,6/71 ; X^2 =34.49, P〈 0. 001 ）was significantly lower than that in the thrombolytic treatment group （54.29% ,38/70 ）. Conclusion Facilitated PCI via a transradial approach therapy might signifieantly inhibit left ventrieular remodeling and improve the left ventrieular function and systolic synehrony by the complete, persistent pateney of IRA, whieh was superior to primary PCI or thrombolytie treatment therapy.