静脉溶栓后选择性PCI对急性心肌梗死患者远期预后的影响

目的探讨静脉溶栓后选择性经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者远期预后的影响.方法AMI患者114例,60例仅接受静脉溶栓者为药物组,54例静脉溶栓后平均(9.1±2.4)d行PCI者为手术组,分别于溶栓后及PCI后3、6、12个月随访主要心脏不良事件(MACE)发生情况.随访复查超声心动图,计算左室的整体室壁运动指数和左室射血分数.结果两组住院期间无死亡及心绞痛复发,手术组血管造影和操作成功率均为100%,无操作相关心肌梗死、急诊冠脉搭桥术(CABG).随访期间死亡率、因不稳定型心绞痛或心绞痛复发再次入院者手术组均显著少于药物组(P＜0.05),手术组总的临床终点事件发生率明显低于药物组(P＜0.01).结论 AMI患者静脉溶栓后选择性PCI能改善其远期预后.

Effect of seletive percutaneous coronary intervention after thrombolytic therapy on the long-term prognosis of patients with acute myocardial infarction

Objective:To evaluate the effect of selective percutaneous coronaryintervention(PCI) after thrombolytic therapy on the long-term prognosis of acute myocardial infarction(AMI) in elderly patients.Methods: 114 patients withAMI were randomly divided into two groups: 60 patients received thrombolytic therapy only (group A),selective PCI was performed after thrombolytic therapy in the other 54 patients(group B).Major adverse cardiac events(MACE) of all patients was followed up at 3,6,12 months after thrombolytic therapy or selective PCI.The left ventricular wall motion score index(WMSI) and left ventricular ejection fraction were calculated by echocardiography.Results: There was no cardiacdeath and recurrent angina in hospital stay in two groups.The success rate ofcoronary angiography and PCI was 100%.The mortality in group B was more lower than group A(P<0.05).The rate of MACE was 22.22% in groupB and 63.15% in group A(P<0.01).Conclusion: SelectivePCI after thrombolytictherapy may improve the long-term prognosis of AMI in elderly patients.