急诊和择期冠状动脉介入治疗对急性心肌梗死左心室重构和功能的影响

目的评价急性心肌梗死(AMI)患者接受急诊和择期经皮冠状动脉介入(PCI)治疗对左心室重构和收缩功能的影响。方法对48例初次发病,发病时间在12h以内或12～24h之间的AMI患者行急诊PCI术;对27例AMI患者行择期PCI术。于术后2周、3个月和6个月行二维超声心动图测量左心室收缩末容积指数(LVESVI)、左心室舒张末容积指数(LVEDVI)、左心室射血分数(LVEF)和梗死区室壁运动指数(RWMI),并进行对比。结果术后2周、3个月急诊PCI组LVESVI、LVEDVI、LVEF和RWMI均显著优于择期PCI组。两组3个月和6个月时LVESVI、LVEDVI、LVEF及RWMI与2周时比较均有显著改善。至6个月时,两组间LVEDVI、LVEF和RWMI比较差异无统计学意义(P>0.05),而LVESVI差异有统计学意义(P<0.05)。两组间GWMI在各时间点统计差异无统计学意义。结论急诊PCI及择期PCI均可有效抑制左心室重构和改善左心室功能,急诊PCI更优于择期PCI。

Influence of emergency and selective percutaneous coronary intervention on ventricular remodeling and function in patients with acute myocardial infarction

Objective To evaluate the influences of emergency and selective percutaneous coronary intervention(PCI) on ventricular remodeling and function in patients with acute myocardial infarction(AMI).Methods Emergency PCI was performed on patients with AMI within 12 to 24 hours of onset.Selective PCI was performed on those patients without indication of emergency PCI.After about 2 weeks,3 or 6 months of the operation,Echocardiography was performed to evaluate index of end systolic volume( LVESVI),end diastolic volume(LVEDVI),ejection fracture(LVEF) and relative wall movement(RWMI) of left ventricle.Results There were 75 patients selected in this study,48 cases in emergency PCI group and 27 cases in selected PCI group.After two weeks of PCI,compared with the selective group,the LVESVI,LVEDVI,LVEF and RWMI were significantly improved in emergency PCI group.In selective group,the LVESVI,LVEDVI,LVEF and RWMI were significantly better in 3 and 6 months compared with those in 2 weeks after PCI.In 6 months after PCI,LVEDVI,LVEF and RWMI were not significantly different in the two groups,except of LVESVI.The indexes of globe wall movement were not significantly different in the two groups at all the time points.Conclusion Both the direct and selective PCI can inhibit left ventricular remodeling and improve left ventricular function.Emergency PCI is better than selective PCI.