急性心肌梗死的延迟冠状动脉介入治疗

目的 探讨延迟冠状动脉介入治疗的疗效及安全性。方法 回顾性分析我院2003年4月～2006年3月发病超过12h 110例急性ST段抬高心肌梗死病人的临床资料。根据其是否接受冠状动脉介入治疗分为：延迟冠脉介入治疗组42例及药物治疗组68例。记录并分析两组住院及随访期间主要心脏事件的发生情况。结果 两组的基本情况除介入治疗组病人的年龄较药物治疗组偏小外．其他临床特征差异无统计学意义（P〉0．05）。介入治疗手术成功率：95％（40／42）。导丝无法通过病变手术失败1例，术后并发蛛网膜下腔出血1例，术中无死亡病例。两组住院及随访期间主要心脏事件发生情况：介入治疗组累计死亡1例（3．1％）；药物治疗组累计死亡7例（10．3％），介入治疗组明显低于药物治疗组（P〈0．001）。主要心脏事件发生率，住院期间介入治疗组为34．5％，药物治疗组为50．0％；随访期间介入治疗组为37．5％，药物治疗组为60．3％。两组差异有统计学意义（P〈0．001）。结论 与常规药物治疗相比，延迟冠状动脉介入治疗安全有效，能明显改善急性心肌梗死的预后。

Delayed percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

Objectives To evaluate the safety and efficacy of delayed percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Methods The data of 110 patients with acute ST-segment elevation myocardial infarction after 12 hours symptom onset from April 2003 to May 2006 were analyzed retrospectively. 42 patients underwent delayed percutaneous coronary intervention(PCI) and 68 patients received conservative drug therapy. They were divided delayed percutaneous coronary intervention group and drug therapy group. Major adverse cardiac events(MACE) were recorded during in-hospital duration and follow-up period. Results The baseline characteristics and drug treated of two groups were similar except age was higher in conservative drug therapy group than delayed PCI group. The success rate of operation in PCI group was 95%. The guide wire failed to pass through the occlusion lesion in 1 case. One case occurred subarachnoid hemorrhage after operation. No death occurred during operation. One death occurred in delayed PCI group and seven death occurred in conservative drug therapy group during hospitalization and follow-up period,death rate was 3.1% and 10.3% respectively. The mortality was significant higher in conservative drug therapy group than in delayed PCI group (P<0.001). Major adverse cardiac events (MACE) rate in delayed PCI group and in conservative drug therapy group during hospitalization and follow-up period were 34.5% vs 50%and 37.5% vs 60.3%,respectively. Total MACE rate was significant higher in conservative drug therapy group than in delayed PCI group (P<0.001). Conclusions Delayed PCI is safety and efficacy,it can further improve the progresis of STEMI.