AMI初期支架植入和rt-PA静脉溶栓加补救支架植入的比较  

Primary Intracoronary Stenting in Comparison with Intravenous rt-PA Thrombolysis Plus Rescue Intracoronary Stenting in Patients with Acute Myocardial Infarction

作　　者：张大东[1] 蔡煦[1] 张瑞岩[1] 张建盛[1] 沈卫峰[1] 

机构地区：[1]上海第二医科大学瑞金医院心脏科,上海200025

出　　处：《上海第二医科大学学报》2001年第4期335-337,共3页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的比较急性心肌梗塞 (AMI)患者冠状动脉内初期支架植入和静脉rt-PA溶栓加补救支架植入治疗的临床疗效。　方法 98例首次AMI患者随机给以冠状动脉内初期支架植入 (初期支架组 :48例 )和静脉rt -PA溶栓加补救支架植入 (溶栓加支架组 :5 0例 )。所有患者行急诊冠状动脉造影以TIMI血流分级法判断梗塞相关冠状动脉 (IRA)开通情况 ;记录住院期心脏事件 :出院前用二维超声心动图测定两组患者左心室舒张末期和收缩末期容量并推算左心室射血分数 (LVEF)。　结果急诊冠状动脉造影显示支架组 47例 (97.91% ) ,溶栓加支架组 5 0例(10 0 % ) ,IRA血流TIMI 2～ 3级 ,但前者IRA前向血流TIMI 3级者明显增多 (分别为 93.8%和 6 0 .0 % ,P =0 .0 0 0 1)。两组患者住院期死亡率和心脏事件相似 ,但出院前超声心动图显示支架组LVEF(6 2 .0 1%± 14.0 3% )高于溶栓加支架组 (5 0 .0 1%± 132 % ,P =0 .0 0 0 1)。　结论与静脉rt-PA溶栓加补救支架治疗相比 ,AMI初期支架植入可更好改善急性期心肌再灌注 。Objective This study is to compare primary stenting in the infarct-related coronary artery with intravenous rt-PA therapy plus rescue intracoronary stenting with respect to clinical and angiographic outcomes of patients with acute myocardial infarction (AMI). Methods Ninety-eight patients with the first attack of AMI were randomly treated with primary intracoronary stenting (primary stenting group) or with intravenous rt-PA therapy plus rescue intracoronary stenting (thrombolysis plus stenting group). The flow grade of thrombolysis in myocardial infarction (TIMI) was assessed by angiography in emergency, and cardiac function (left ventricular ejection fraction, LVEF) was calculated by echocardiography before discharge in both groups. Results 47 patients (97.91%) in the primary stenting group and 50 patients (100%) in the thrombolysis plus stenting group had achieved TIMI grade 2 ～ 3 flow after the procedure. But more cases in the former group (93.8%) had TIMI 3 flow than the latter group (60.0%) (P=0.0001). There was no difference between the two groups in cardiac events during hospitalizaton. But the patients in the primary stenting group had better cardiac function (LVEF 0.62±0.14vs0.50±0.12, P=0.0001). Conclusion Primary intracoronary stenting may improve myocardial reperfusion in emergency and inhibit the decline of cardiac function after AMI in comparison with intravenous rt-PA thrombolysis plus rescue intracoronary stenting.

关 键 词：心肌梗塞 溶栓疗法 支架植入 RT-PA 治疗 

分 类 号：R542.22[医药卫生—心血管疾病]