延迟PCI与药物保守治疗急性ST段抬高型心肌梗死的疗效比较

摘要： 目的 探讨延迟经皮冠状动脉介入 （延迟PCI， 发病12~24 h内直接PCI） 与药物保守治疗急性ST段抬高型心肌梗死 （STEMI） 的疗效差异。方法 采用前瞻性、 开放、 平行、 对照的研究方法， 将186例发病12~24 h的STEMI患者分为延迟PCI组89例 （STEMI后12~24 h内接受PCI治疗） 和药物保守治疗组97例 （单纯接受冠心病二级预防药物治疗）， 平均随访 （5.6±1.4） 个月， 比较2组患者住院周期的差别； 比较2组患者住院期间、 出院后30 d及6个月左房直径 （LAD）、 左室舒张末径 （LVDd）、 左室射血分数 （LVEF）、 左室短轴缩短率 （LVFS） 的变化， 以及住院及随访期间主要心脏不良事件及复合终点事件等发生率的差别。结果 延迟PCI组住院周期明显短于药物保守治疗组， 30 d及6个月随访心脏彩超LAD、 LVDd小于药物保守治疗组， 而LVEF及LVFS大于药物保守治疗组， 住院期间及随访期间复合终点事件、 心脏事件发生率明显低于药物保守治疗组 （P＜0.05）。结论 延迟PCI治疗可减少STEMI患者平均住院时间， 降低复合终点事件及主要心脏事件发生率， 改善左室功能及预后。

Comparison of the curative effect between delayed PCI and medical therapy on ST-segment elevation acute myocardial infarction

Abstract: Objective To investigate and compare the curative effect between delayed percutaneous coronary intervention (PCI) for patients with acute myocardial infarction presenting 12-24 hours from symptom onset and medical therapy on acute myocardial infarction patients presenting with ST-segment elevation (STEMI). Methods Using a prospective, open, parallel, controlled research approach, 186 patients with STEMI were divided into delayed PCI group (n＝ 89), which received PCI within 12-24 hours after STEMI and medical therapy group (n=97), which received medical therapy after STEMI. All patients were followed up 1-6 months with average follow-up (5.6±1.4) months. Data of hospitalization period, the cardiac structures detected by echocardiography such as left atrial diameter (LAD), left ventricular diastolic diameter (LVDd), left ventricular ejection fraction LVEF, left ventricular fractional shortening (LVFS), composite end point events and major adverse cardiac events (MACE) were compared between the two groups. Results Compared with medical therapy group, the hospitalization cycle was significantly shorter in delayed PCI group. Data of the LAD and LVDd were significantly decreased, but LVEF and LVFS were increased in delayed PCI group compared with those of medical therapy group at 30 d and 6-month follow-up. The incidence of MACE and composite end point events were significantly less in delayed PCI group than those of medical therapy group (P＜0.05). Conclusion Delayed PCI treatment can decrease the time of hospital stay and decrease the incidence rates of MACE and composite end point events, and improve left ventricular function and prognosis of patients.