急性心肌梗死中缺血预适应可否保护心肌

目的探讨心肌梗死前心绞痛对心肌产生的缺血预适应,对行经皮冠状动脉介入术急性心肌梗死患者是否有近期及远期的保护作用。方法急性心肌梗死113例,介入术组(68例)行急诊经皮冠状动脉介入术,非介入术组(45例)没行再灌注治疗。观察急性心肌梗死前48h有否心绞痛发作,再分为心绞痛阳性和心绞痛阴性两亚组。观察两组患者的预后。结果介入术组的心绞痛阳性和心绞痛阴性两亚组住院期间心力衰竭、心源性休克、心肌酶峰值、心源性死亡、左室射血分数以及随诊期心力衰竭、心绞痛发生率、心源性死亡的差异无统计学意义(P>0.05);非介入术组的AP阳性亚组住院期间心力衰竭、心源性休克、心肌酶峰值及达峰时间均较低、左室射血分数较高,差异有统计学意义(P<0.05),随诊期心绞痛发生率、心源性死亡似有增高趋势,但差异无统计学意义(P>0.05)。结论心肌梗死前心绞痛对行经皮冠状动脉介入术的急性心肌梗死患者保护作用不显著,对没行再灌注治疗的急性心肌梗死患者,可改善近期预后,但远期保护作用不明显。

Comparison of protective effects of preinfarction angina pectoris in acute myocardial infarction treated by percutaneous coronary intervention and non-reperfusion

Objectives To evaluate protective function of ischemia preconditioning in patients with acute myocardial infarction(AMI) undergoing percutaneous coronary intervention (PCI). Methods We studied 113 patients with AMI. Group 1(n=68) was treated with PCI and Group 2(n=45) non-reperfusion. Each group was divided into 2 subgroups: patients with or without preinfarction angina. Results In group 1, it was similar between patients with or without preinfarction angina in the incidence of in-hospital congestive heart failure (CHF), cardiogenic shock and death, left ventricular ejection fraction (LVEF), and peak creatine kinase(P>0.05). In the follow-up, occurrence of cardiac events was not statically different either. In group 2,however, there were differences between patients with or without preinfarction angina in CHF, cardiogenic shock and death, and peak creatine kinase in hospital(P<0.05),but the long-term cardiogenic death,angina attack was more frequent in the patients with preinfarction angina(P >0.05). Conclusions The protective effect of preinfarction angina in AMI are not evident in those treated with PCI, while in those non-reperfusion, it seems to confer significant protection against in-hospital outcomes.