直接PCI与溶栓后即刻和补救PCI对AMI患者近期心功能的影响

目的　评价直接经皮冠状动脉介入治疗 (PCI)与小剂量rt -PA溶栓后即刻和补救PCI对急性心肌梗死 (AMI)患者的有效性和安全性 ,并观察其对近期左室重构及功能的影响。方法　对初次发病、发病 6h内且无溶栓禁忌症的AMI患者随机给予直接PCI或小剂量rt -PA溶栓加即刻和补救PCI治疗 ,于术后 3、3 0、90d行二维超声心动图检查并记录有关心脏事件。结果　共入选63例患者 ,随机分为直接PCI组 (对照组 ,A) 3 2例 ,溶栓加补救PCI组 (观察组 ,B) 3 1例。依据首次造影血流是否达TIMI 3级将所有病人再分为两组。术后 3、3 0、90d两组间左室收缩末期容积指数 (ESVI)、左室舒张末期容积指数 (EDSI)、左室射血分数 (EF)和室壁运动指数 (WMSI)均无显著差异 ( P >0 0 5 ) ;各组内 3 0d、90d与 3d比较均有显著差异 ;首次造影血流达TIMI 3级组与未达TIMI 3级组 3 0、90d各指标均显著改善。结论　直接PCI与小剂量rt -PA溶栓后即刻和补救PCI同样安全有效 ,改善左室功能并降低心脏事件的发生。

Effect of Primary PCI and Post-thrombolysis Immediate Rescue PCI on Left Ventricular Function of Patients with Acute Myocardial Infarction

Objective To evaluate effect and safty of primary percutaneous coronary intervention (PCI) versus reduced-dose rt-PA thrombolysis with immediate planned rescue PCI on the patients with acute myocardial infarction(AMI). Methods 63 patients with the first acute myocardial infarction within 6 hours from the onset of symptoms and without the contraindiction of thrombolytic therapy were randomly divided into primary PCI group (group A,32) and rt-PA thrombolytic therapy with immediate rescue PCI group (group B,31). Two-dimensional echocardiography was applied to record major cardiac events at the 3, 30 and 90 days after PCI. Results All patients were further divided into two groups according to TIMI-3 value. The differences of end-systolic volume index (ESVI),end-diastolic volume index (EDVI),left ventricular ejection fraction (LVEF) and wall motion scores index(WMSI) were not significant between group A and group B (P>0.05) at 3, 30 and 90 days after operation. The differences of ESVI, EDVI, LVEF and WMSI were significant between 30d,90d and 3d in every group(P<0.05). The differences of ESVI, EDVI, LVEF,WMSI were significant between TIMI-3 group and non-TIMI-3 group at 30d and 90d after operation. Conclusion There were identical effect and safty using primary PCI or reduced-dose rt-PA thrombolysis with immediate rescue PCI in the patients with AMI. They reduced cardiac events and improved left ventricular function and remodeling.