不同方法治疗急性心肌梗塞近、远期疗效的对比研究
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摘要
目的:通过分析研究不同方法治疗289例急性心肌梗死(AMI)患者近、远期疗效,评价直接经皮冠状动脉介入术(PCI)治疗AMI的安全性及有效性,探讨直接PCI对急性心肌梗死治疗价值。
方法:收集了338例急性心肌梗死患者临床资料,均为2001年1月～2005年6月苏州大学附属第一医院心内科住院病人。对上述病例进行随访,平均随访8～56个月,观察心脏死亡事件、再梗死、靶血管血运重建术的发生率,观察心绞痛发作、心功能情况。共随访到289例,随访率85.5%。对随访到的289例病人根据住院期间治疗方法分组,第一组:直接PCI组96例,直接PCI组分直接支架植入亚组78例;单纯PTCA亚组18例;第二组:择期PCI组63例;第三组:溶栓组34例;第四组:一般治疗组96例。对四组病例进行回顾性分析,比较各组一般资料,近、远期疗效(死亡率,心脏事件及并发症发生率)。
结果:1、四组病人性别、合并高血压、糖尿病、陈旧性心梗、梗死部位、LVEF、入院心功能分级、入院一般治疗及常规用药无统计学差别(P>0.05);冠脉介入治疗的两组(直接PCI组与择期PCI组)CAG结果、IRA、术后TIMI血流分级、手术成功率无显著差别(P>0.05);一般治疗组病人的年龄高于择期PCI组(P<0.05),而其他三组差别无统计学意义;2、冠脉介入治疗和溶栓治疗能明显降低急性心梗病人住院期间死亡率:直接PCI组为(4.2%)、择期PCI组(4.8%)、溶栓组(5.9%)、一般治疗组10.4%),一般治疗组高于其他三组,比较有统计学意义(P<0.05);3、冠脉介入治疗尤其直接PCI治疗急性心肌梗死,能明显降低住院及随访期间联合终点(心脏死亡事件、非致命性再梗死、靶血管血运重建术)发生率和次要终点(心力衰竭、再缺血发作)的发生率;4、四组住院期间:出血、脑卒中并发症无统计学差别(P>0.05); 5、直接PCI组住院及随
Objectives : To explore the safety,the efficacy and the value of primary percutaneous coronary intervention in acute myocardial infarction, through the study of recent effect and long-term prognosis in different kinds of therapy for 338 patients of acute myocardial infarction.
Methods : All 338 patients with acute myocardial infarction were hospitalized patients in the Medical Department of cardiology of The First Hospital Affiliated to Suzhou University from the year2001 to 2005.An average period of followed up time is 8-56 months,The mortality rates, myocardial infarction, or target vessel revascularization ,angina pectoris, Cardiac function were observed.The following up rate was 85.5% and 289 patients were enrolled. 289 patients with AMI were assigned to four groups according to different kinds of therapics: 1, Primary Percutaneous Coro- nary Intervention group(96 patients),The group were subdivided into primary stent implantation group(78 patients) and Percutaneous Transluminal Coronary Angiplasty group(18 patients); 2, Elective Percutaneous Coronary Intervention group (63 patients); 3, Intravenous thrombolytic therapy group(34 patients); 4, General treatment group(96 patients).The Short-term and Long-term Therapeutics Effects (the morta- lity, incidence rate major adverse cadiac event and complication) were compared, retrospectively.
Results : 1, There was no significant difference in Sex, complicating hyperten- sion, diabetes, old myocardial infarction, infarct location, left ventricular ejection fraction, Killip’s grading and general treatment among the four groups (P>0.05). There was also no significant difference in Coronary angiography, Infarcted relative artery, Thrombolysis in myocardial infarction grading, achievement ratio between the twe groups (Primary PCI group and Elective PCI group). Age in the Primary PCI group was higher than the Elective PCI group(P<0.05),while there is no apparent difference in age among other three groups(P>0.05); 2, Percutaneous Coronary Intervention and Intravenous thrombolytic therapy in patients with acute myocardial infarction can decrease in- hospital mortality , the primary PCI group (4.2%), the elective PCI group(4.8%), the thrombolytic therapy
方法:收集了338例急性心肌梗死患者临床资料,均为2001年1月～2005年6月苏州大学附属第一医院心内科住院病人。对上述病例进行随访,平均随访8～56个月,观察心脏死亡事件、再梗死、靶血管血运重建术的发生率,观察心绞痛发作、心功能情况。共随访到289例,随访率85.5%。对随访到的289例病人根据住院期间治疗方法分组,第一组:直接PCI组96例,直接PCI组分直接支架植入亚组78例;单纯PTCA亚组18例;第二组:择期PCI组63例;第三组:溶栓组34例;第四组:一般治疗组96例。对四组病例进行回顾性分析,比较各组一般资料,近、远期疗效(死亡率,心脏事件及并发症发生率)。
结果:1、四组病人性别、合并高血压、糖尿病、陈旧性心梗、梗死部位、LVEF、入院心功能分级、入院一般治疗及常规用药无统计学差别(P>0.05);冠脉介入治疗的两组(直接PCI组与择期PCI组)CAG结果、IRA、术后TIMI血流分级、手术成功率无显著差别(P>0.05);一般治疗组病人的年龄高于择期PCI组(P<0.05),而其他三组差别无统计学意义;2、冠脉介入治疗和溶栓治疗能明显降低急性心梗病人住院期间死亡率:直接PCI组为(4.2%)、择期PCI组(4.8%)、溶栓组(5.9%)、一般治疗组10.4%),一般治疗组高于其他三组,比较有统计学意义(P<0.05);3、冠脉介入治疗尤其直接PCI治疗急性心肌梗死,能明显降低住院及随访期间联合终点(心脏死亡事件、非致命性再梗死、靶血管血运重建术)发生率和次要终点(心力衰竭、再缺血发作)的发生率;4、四组住院期间:出血、脑卒中并发症无统计学差别(P>0.05); 5、直接PCI组住院及随
Objectives : To explore the safety,the efficacy and the value of primary percutaneous coronary intervention in acute myocardial infarction, through the study of recent effect and long-term prognosis in different kinds of therapy for 338 patients of acute myocardial infarction.
Methods : All 338 patients with acute myocardial infarction were hospitalized patients in the Medical Department of cardiology of The First Hospital Affiliated to Suzhou University from the year2001 to 2005.An average period of followed up time is 8-56 months,The mortality rates, myocardial infarction, or target vessel revascularization ,angina pectoris, Cardiac function were observed.The following up rate was 85.5% and 289 patients were enrolled. 289 patients with AMI were assigned to four groups according to different kinds of therapics: 1, Primary Percutaneous Coro- nary Intervention group(96 patients),The group were subdivided into primary stent implantation group(78 patients) and Percutaneous Transluminal Coronary Angiplasty group(18 patients); 2, Elective Percutaneous Coronary Intervention group (63 patients); 3, Intravenous thrombolytic therapy group(34 patients); 4, General treatment group(96 patients).The Short-term and Long-term Therapeutics Effects (the morta- lity, incidence rate major adverse cadiac event and complication) were compared, retrospectively.
Results : 1, There was no significant difference in Sex, complicating hyperten- sion, diabetes, old myocardial infarction, infarct location, left ventricular ejection fraction, Killip’s grading and general treatment among the four groups (P>0.05). There was also no significant difference in Coronary angiography, Infarcted relative artery, Thrombolysis in myocardial infarction grading, achievement ratio between the twe groups (Primary PCI group and Elective PCI group). Age in the Primary PCI group was higher than the Elective PCI group(P<0.05),while there is no apparent difference in age among other three groups(P>0.05); 2, Percutaneous Coronary Intervention and Intravenous thrombolytic therapy in patients with acute myocardial infarction can decrease in- hospital mortality , the primary PCI group (4.2%), the elective PCI group(4.8%), the thrombolytic therapy
引文
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2. ISIS-2 Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS-2.Lancet, 1988,2:349.
3. Simes RJ, Topol EJ, Holmes DR, et al. For the GUSTO-I Investigation. Link between the angiographic substuty and mortality outcome in a large randomized trial of myocardial reperfusion: importance of early and complete infarct artery reperfusion. Circulation, 1995, 91:1923-1928.
4. GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction . N Engl J Med, 1993, 329:673-682.
5. PAMI Grines CL, Broun KF, Marco J, et al. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. N Engl J Med, 1993, 328(10):673-679.
6 . 高润霖,冠心病介入治疗进展,中国循环杂志,2001,16(增刊): 149-155.
7. Piana RN, Paik GY, Mosucci M, Cohen DJ, Gibson CM, et al. Incidence and treatment of no reflow after percutaneous coronary intervention. Circulation, 1994, 89:2514-2518.
8. Feld H, Lichstein E, Schani J. Early and late angiographic findings of the “no-reflow” phenomenon following direct angioplasty as primary treatment for acute myocardial infarction. Circulation, 1992, 123:782-784.
9. 胡大一,崔亮,魏妤,等。直接经皮冠状动脉成型术与溶栓治疗急性心肌梗死近期疗效分析。中华心血管病杂志,1998,26:420-422.
10. Saito S, Hosokawa FG , Kim K , et al. Primary stent implantation without coumadin in acute myocardial infarction . J Am Coll Cardiol , 1996,28:74-81.
11. 中华医学会心血管病学分会中华心血管病杂志编辑委员会. 经皮冠状动脉介入治疗指南[J].中华心血管病杂志2002 年12 月第30 卷第12 期.
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