急性心肌梗死溶栓后常规早期行血管重建的临床研究

目的若ST段抬高性心肌梗死患者不能立即行急诊PCI,则应行溶栓治疗。但目前为止还未确定溶栓治疗后行常规PCI的作用及理想时间。因此,本研究将溶栓后6h内常规早期PCI与溶栓失败后行补救性PCI的治疗方案进行比较。方法随机选择接受了溶栓治疗的266例高危的STEMI患者,并在溶栓6h后行PCI治疗。在30d及6个月时对患者进行随诊。原始终点为30d内发生死亡、再发心肌梗死、再发心肌缺血、新发充血性心力衰竭或原有心衰加重。结果在第30天,常规早期PCI治疗的患者原始终点发生率低于常规治疗的患者(相对危险度为0.64;95%可信区间0.47vs0.87;P=0.004)。而在第6个月时,两组再梗死的发生率和死亡率比较差异无统计学意义(相对危险度为0.83;95%可信区间0.55vs1.25;P=0.360)。结论 STEMI的高危患者溶栓治疗后,在6h内即进行PCI治疗可显著改善心脏预后,但远期效果仍需要进一步观察。

Routine Early Angioplasty Following Thrombolysis in Acute Myocardial Infarction

Objective If ST segment elevation myocardial infarction with ST segment elevation fail to undergo emergency PCI immediately,thrombolytic treatment should be carried out,and the role and optimal timing of routine PCI after thrombolysis have not been established. Methods We randomly assigned 266 high-risk patients with myocardial infarction with ST-segment elevation who received thrombolysis therapy to either standard treatment or a strategy of immediate PCI within 6 hours after thrombolysis. The primary end point was set as the occurrence of death,recurrence of myocardial infarction,recurrent myocardial ischemia,new congestive heart failure or original heart failure worsening within 30 days. Results On Day 30,the incidence of the original endpoint of the routine early PCI patients was lower than that of the patients with conventional treatment （relative risk with early PCI,0.64; 95% confidence interval,0.47 to 0.87;P=-0.004）. Conclusion The measure that high-risk patients with STEMI after thrombolysis receive PCI treatment within 6 hours can significantly improve cardiac prognosis,but long-term effect still need to be observed.