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延迟性血运重建术对溶栓失败的急性心肌梗死患者近远期预后的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2004年第6期
页码:
550-552
栏目:
临床研究
出版日期:
2004-11-01

文章信息/Info

Title:
Effect of immediate and long term cl inical prognosis of delayed percutaneous intervention af ter failed thrombolysis on the patients with AMI
作者:
罗助荣;  盖晓波
南京军区福州总医院心内科, 福建福州350025
Author(s):
LUO Zhu-rong ;  GAI Xiao-bo
Department of Cardiology , Fuzhou General Hospital of Nanjin Army , PLA , Fuzhou , Fujian 350025 ,China
关键词:
延迟性冠脉介入; 经皮; 心肌梗塞; 急性; 血栓溶解疗法
Keywords:
delayed coronary intervention ; percutaneous ;  myocardial infarction ;  acute ;  thrombolytic therapy
分类号:
R542. 22
DOI:
-
文献标识码:
A
摘要:
目的:对比研究延迟经皮冠状动脉内成形术(PTCA) 及支架植入术( ICS) 与静脉溶栓术( IT) 对急性心肌梗死(AMl) 患者近期及远期预后的影响。方法:将61 例初次AMI 分为3 组,即溶栓失败组(A 组) 15 例、静脉溶栓成功组(B 组) 20 例、延迟血运重建术(PCI) 组(C 组) 26 例。根据梗塞相关动脉开通情况,A 组为溶栓失败而未行PCI 者给一般药物治疗,C 组入院后溶栓失败或失去溶栓时机7～30 d 后行延迟PCI 治疗。结果: ①住院期间B 组和C 组平均住院天数、住院期死亡及复合终点事件(不稳定型心绞痛、心肌梗死和死亡总和) 的发生率、室壁运动异常积分指数等指标均低于A 组( P < 0. 05) ,而B 组和C 组之间比较无明显差异( P > 0. 05) 。②随访期间C 组左室扩大、室壁瘤形成、死亡及复合终点事件和再狭窄等发生率均低于B 组及A 组( P < 0. 05) 、存活率及射血分数显著高于B组及A 组( P < 0. 05) ,且B 组又显著高于A 组( P < 0. 05) 。结论:失去溶栓时机或溶栓失败的AMI 患者积极行延迟PTCA 及支架植入治疗,对改善近期及远期预后是有益的,能减少住院期间心脏事件发生,并挽救存活心肌,减轻心室重构,促进心功能改善,提高存活率。
Abstract:
AIM: To compare the short and long term clinical prognoss of delayed percutaneous intervention (PCI) with int ravenous hrombolyticl ( IT) therapy in patient s with acute myocardial infarction (AMI) . METHODS : 61 patient s with AMI were divided into unsuccesed IT therapy group (group A ,15 cases) , IT therapy group (group B ,20 cases) and delayed PCI group (group C ,26 cases) . After administ ration of unsuccesed IT therapy about 7～30 days , 15 cases of Group A were received routine t reatment ,26 cases of group C were given delayed PCI. RESULTS : ①No significant difference was observed in the contex inhospital cardiac event s between group C and group B( P > 0. 05) , but the inhospital cardiac event rate in group A was higher in group C and group B( P < 0. 01) . ②During follow up period (190 + 23 days) ,the occurrence rates of cardiac event s and cardiac death were lower in group C than in group B and A ,and group B was lower group A( P < 0. 05) . The restenosis rate of infarct related artery were lower in group C than in group B and A ,and group B was lower group A( P < 0. 05) . The survival rate and LVEF were higher in group C than in group B and A ( P < 0. 05) . CONCLUSION: Delayed PCI for failed thrombolysis patient s with AMI is a good choice of revascularization and a better outcomes of improving short and long term clinical prognoss. It can decrease long-term cardiac event s ,ret rieve viable myocardium , preserve cardiac function ,and increase survival rate.

参考文献/References

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[ 2 ] Caspi A , Gottlieb S , Behar S , et al . Delayed percutaneous transluminal coronary angioplasty after acute myocardial infarction[J ] . Int J Cardiol , 1998 ,63 :199 - 204.

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备注/Memo

备注/Memo:
收稿日期：2004-2-16
更新日期/Last Update: 2004-11-01