延迟冠状动脉介入治疗与静脉溶栓后药物保守治疗的对比研究

目的　评价静脉溶栓治疗后常规行延迟冠状动脉介入 (PCI)的价值。方法　对 98例ST段抬高性心肌梗死 (STEMI)患者常规行延迟PCI,然后与既往行静脉溶栓后药物保守治疗的 82例患者对照观察住院期间和随访 6个月时的临床不良事件和超声心动图的变化。所有患者分为对照组 (静脉溶栓后保守治疗 )、试验 1组 (静脉溶栓成功后行延迟PCI)和试验 2组 (静脉溶栓失败后行延迟PCI)。结果　与静脉溶栓保守治疗比较 ,静脉溶栓后常规施行延迟PCI可以降低住院期间的死亡率(4 9%vs 0 % ,0 % )、缩短平均住院时间 (2 5 3dvs13 5d ,15 1d)、减少对靶病变血管重建治疗的需要(7 3%vs 0 % ,0 % )和降低血栓形成或心肌梗死的发生率 (7 3%vs 0 % ,0 % ) ,还可以明显降低 6个月死亡率 (13 4 %vs 1 4 % ,0 % )、减少再次心肌梗死 (12 2 %vs 4 2 % ,4 5 % )和卒中 (2 4 %vs 0 % ,0 % )的发生、减少因缺血做靶血管重建治疗 (2 8%vs 4 2 % ,4 5 % )和防止左室进一步发生重塑。结论　常规施行延迟PCI可以防止再发性缺血、再次梗死和梗死相关动脉再闭塞和改善左室功能 ,因而提高住院期间和 6个月的治疗效果。

elayed percutaneous coronary intervention versus conservative strategy after thrombolysis for ST-segment elevation myocardial infarction

Objective To evaluate the role of routine delayed percutaneous coronary intervention (PCI) after thrombosis in the management of patients with ST-segment elevation myocardial infarction. Methods Ninety-eight patients with STEMI who underwent routine delayed PCI after thrombosis and other 82 patients with STEMI who were given conservative strategy after thrombolysis were enrolled in this study and were investigated during their in-hospital period and 6-month follow-up regarding major adverse clinical events (MACE) and the cardiac structure and function by echocardiography. The patients were divided into the control group (conservative strategy after thrombolysis), therapy group 1 (routine delayed PCI after successful thrombolysis), and therapy group 2 (routine delayed PCI after unsuccessful thrombolysis). Results Compared with conservative strategy after thrombolysis, routine delayed PCI after thrombosis decreased in-hospital mortality (4.9% vs 0%, 0%), shortened average hospital stay (25.3 days vs 13.5 days, 15.1days), decreased the need for revascularization for target lesion (7.3% vs 0%, 0%) and lowered the incidence of thrombosis or infarction (7.3% vs 0%, 0%), and also produced lower mortality (13.4% vs 1.4%, 0%), prevented reinfarction (12.2% vs 4.2%, 4.5%) and stroke (2.4% vs 0%, 0%), decreased the need for revascularization for target lesion (28% vs 4.2%, 4.5%) and prevented further left ventricle remodling. Conclusion Routine delayed PCI after thrombosis may to prevent recurrent ischemia, reinfarction, and reocclusion, so as to improve immediate results and 6-month prognosis.