直接或延迟PCI对治疗急性心肌梗死的比较

目的：探讨急诊经皮冠状动脉介入（PCI）与延迟PCI在治疗急性心肌梗死（AMI）疗效的差异.方法：200例AMI患者中80例在发病12 h内行直接PCI.另外120例行延迟PCI.分析2组患者一般临床特征及心血管事件的发生率,术后7～10 d做超声心动图,对比左心室射血分数（LVEF）,左心室舒张末期容积指数（EDVI）和收缩末期容积指数（ESVI）以评价心功能.结果：直接PCI组不稳定性心绞痛、非致死性心衰较延迟PCI组明显降低（12.50%vs 24.17%,10.00%vs 21.67%,P＜0.05）.术中直接PCI组发生室颤、窦停或严重窦缓率高于延迟PCI组（12.50%vs 2.50%,17.50%vs 6.67%,P＜0.05）;而心源性死亡无增加.直接PCI组近期EDVI、ESVI、LVEF优于延迟PCI组.结论：AMI患者行急诊PCI术中室颤、窦停或严重窦缓的发生率较延迟PCI组增多,但急诊PCI可以有效开通梗死相关冠状动脉,恢复梗死区域心肌血流灌注,使左室功能得到改善.

Comparison between Primary and Delayed PCI in Patients with Acute Myocardial Infarction

Objective: To evaluate the efficacy between primary percutaneous coronary intervention (PCI) and delayed PCI in patients with acute myocardial infarction (AMI). Methods: Two hundred patients with AMI were treated with either primary PCI (80 cases) or delayed PCI(120 cases). The general clinical characteristics and cardiac events were analysed. Left ventricular ejection fraction (LVEF), end diastolic volume index (EDVI) and end systolic volume index (ESVI) of the left ventricle were measured by two-dimensional echocardiography 7-10 days after PCI. Results: Unstable angina (12.50% vs 24.17%,P < 0.05) and non-fatal heart failure (10.00% vs 21.67%, P < 0.05) decreased significantly in primary PCI group compared to those in delayed PCI group. The incidence of arrhythmia during the operation in primary PCI group was higher than that of delayed PCI group (67.50% vs 26.67%, P < 0.05). However the cardiac death didn't increase. EDVI, ESVI and LVEF in primary PCI group were much better compared to those in delayed PCI group. Conclusion: The incidence of ventricular fibrillation, sinus arrest and severe sinus bradycardia seems to increase during the operation in primary PCI patients compared to those in the delayed PCI group. Meanwhile, primary PCI can efficiently re-open the infracted coronary artery, reperfuse the myocardial infarction focus and improve the left ventricular diastolic function.