急性心肌梗死后延迟PTCA及支架植入对慢性期左室重构和心脏事件的影响

目的　探讨急性心肌梗死 (AMI)后延迟PTCA及支架术对慢性期左室重构和心脏事件的影响。方法　 5 2例初次AMI患者分为PTCA组 (n =2 7)和非PTCA组 (n =2 5 ) ,PTCA组于发病后平均 12d对梗死相关动脉行PTCA及支架术。随访两组患者的左室收缩末期容积 (LVESV)、左室舒张末期容积 (LVEDV)、左室射血分数 (LVEF)及心脏事件。结果　PTCA组患者术后LVEDV及LVESV与术前比较无显著差异 ,而非PTCA组患者随访后LVEDV及LVESV与随访前比较显著增加 (P <0 .0 5 )。LVEF在两组间无显著差异。PTCA组在心力衰竭 (4 %和 44 % ,P <0 .0 1)和复合终点事件 (33%和 72 % ,P <0 .0 5 )方面较非PTCA组明显下降 ,在死亡、不稳定性心绞痛及再次心肌梗死的发生率方面两组无显著差异。结论　AMI后延迟PTCA及支架术可抑制左室扩大 ,延缓慢性期左室重构 ,并显著减少心脏事件的发生

The effect of delayed PTCA and stenting on chronic phase of left ventricular remodelling and cardiac events in patients with acute myocardial infarction

Objective To investigate the effect of delayed PTCA and stenting for infarct related artery on the chronic phase of left ventricular remodelling and cardiac events in patients with acute myocardial infarction. Methods Fifty two patients with primary acute myocardial infarction were divided into PTCA group ( n =27) and non PTCA group ( n =25). Twenty seven patients underwent PTCA and coronary stenting with an average of 12 days after the acute onset. Left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF) and cardiac events in each group were followed up. Results There were no significant differences in preoperation and postoperation for LVEDV and LVESV in the PTCA group, on the contrary a significant increase for before and after follow up for LVEDV and LVESV in the non PTCA group( P <0.05). No difference for LVEF was found in the two groups. Heart failure (4% vs 44%, P <0.01) and composite events (33% vs 72%, P <0.01) were decreased more significantly in the PTCA group than in the non PTCA group, but there were no significant difference in unstable angina, reinfarct and death of the two groups ( P >0.05). Conclusions Delayed PTCA and stenting for infarct related artery would inhibit ventricular enlargement and delay chronic phase of left ventricular remolding. Moreover, cardiac events were significantly reduced in patients with acute myocardial infarction after delayed PTCA and stenting.