老年ST段抬高急性心肌梗死患者急诊介入与溶栓治疗比较

目的急性心肌梗死（AMI）后尽早恢复梗死相关动脉的再灌注是治疗中的首要问题。本研究旨在评价老年急性ST段抬高性心肌梗死（STEMI）分别接受直接经皮冠状动脉介入（PCI）治疗和溶栓治疗住院及随访期间的临床疗效差别。方法109例65岁以上老年STEMI患者，59例行直接PCI治疗，50例行溶栓治疗。比较2组梗死相关动脉（IRA）再通率、左室功能指标、病死率及主要心血管事件发生率的差别。结果PCI组IRA开通率明显高于溶栓治疗组，住院病死率明显低于溶栓治疗组，左室功能指标明显优于溶栓治疗组（左室射血分数更高、左室舒张末径较小、室壁运动障碍率较低。随访期间比较，PCI组再次血运重建率和心血管病死率明显低于溶栓治疗组。结论老年AMI患者行直接PCI治疗能够显著提高IRA再灌注成功率，保护心功能，减少再次血运重建，并且在降低病死率及心血管事件上也总体优于溶栓治疗。

Comparison of the clinical efficacy of primary percutaneous coronary intervention with thrombolytic therapy for acute ST elevation myocardial infarction in the elderly

Objective To compare the clinical efficacy of primary percutaneous coronary interventions （PCI） with that of thrombolytic therapy for acute ST segment elevation myocardial infarction （STEMI） in the elderly. Methods A total of 109 STEMI patients （age〉 65years） were enrolled. Of them 59 underwent primary PCI, and 50 were treated with thrombolytic drug urokinase. The recanalizing rate of infarction-related artery （IRA）, mortality, left ventricular function and major cardiac events rate between the two groups were compared. Results Clinical out-comes during hospitalzation： in PCI group, the recanalizing rate of IRA was higher, in-hospital mortality was lower, indexes of left ventricular function were better than those in thrombolysis group. Major cardiac event rates during follow-up： The rates of accumulative cardiac mortality and revascularization were lower in PCI group than in thrombolys- is group. Conclusion Compared with the thrombolytic therapy, primary PCI can more rapidly and efficaciously restore the blood flow in IRA, reduce in-hospital mortality of AMI, improve left ventricular systolic function, decrease revascularization possibility of IRA and mortality during follow-up.