曲美他嗪对直接经皮冠状动脉介入治疗后ST段回落不良的心肌梗死患者预后的影响

目的 前瞻性评价曲美他嗪对直接经皮冠状动脉介入(PCI)治疗后ST段回落不良的心肌梗死患者临床预后的影响.方法 2005年8月至2007年10月共入选138例直接PCI治疗后ST段回落不良的急性ST段抬高的前壁心肌梗死患者,分为曲美他嗪治疗组(70例)和对照组(68例).治疗组在术后1h顿服60 mg曲美他嗪,继之以20 mg,3次/d,口服1周.对照组不应用曲美他嗪.比较两组的基线临床状况,出院后30 d、6个月的主要心脏不良事件(MACE,包括死亡,再梗死,再次靶血管重建)发生率和左室射血分数(LVEF).结果 两组的基线临床资料差异无统计学意义.两组出院后30d和6个月的MACE发生率差异亦无统计学意义,分别为14.3 %比16.2 %, (P>0.05); 21.4 %比 19.1%, (P>0.05).治疗组30d和6个月的LVEF显著高于对照组分别为(51±8)%比(45±7)%;(56±7)%比( 49±8)%, (均P<0.01).结论 曲美他嗪对直接PCI后ST段回落不良的急性ST段抬高心肌梗死患者的30d和6个月的MACE无影响,但是可以改善其30 d和6个月的心功能.

Clinical outcomes of trimetazidine in patients with acute ST segment elevation myocardial infarction without ST segment resolution after primary percutaneous coronary intervention

Objective To evaluate prospectively the clinical outcomes of trimetazidine(TMZ)in patients with acute ST segment elevation myocardial infarction(STEMI)without ST segment resolution(STR)after primary percutaneous coronary intervention(PPCI).Methods From August 2005 to October 2007, 138 acute STEMI patients without STR after PPCI were randomly assigned to either with TMZ therapy(TMZ group, n=70)or without TMZ (control group, n=68). Baseline characteristics, PCI features and clinical outcomes during hospitalization were compared between the two groups. Left ventricular ejection fraction(LVEF)and major adverse cardiac events(MACE, including death, re-infarction and target vessel revascularization)at Days 30 and 180 after discharge were also compared.Results The baseline clinical characteristics were comparable between the two groups. There was no significant difference in MACE rates at Days 30 and 180 between the two groups (10/70 vs11/68, P>0.05; 15/70 vs13/68, P>0.05, respectively). The LVEFs of TMZ group at Days 30 and 180 were significantly superior to the control group (51±8)% vs (45±7)%, P<0.05;(56±7)% vs (49±8)%, P<0.05, respectively).Conclusion Use of TMZ for patients with acute STEMI without STR after primary PCI can improve the left ventricular function at Days 30 and 180.