不同经皮冠状动脉介入治疗术支架植入时机对急性ST段抬高型心肌梗死疗效和预后的影响  

Effect of different stent implantation time for percutaneous coronary intervention on efficacy and prognosis of acute ST-segment elevation myocardial infarction

作　　者：曹佳齐[1] 丁跃有[1] 郑宏超[1] Cao Jiaqi;Ding Yueyou;Zheng Hongchao(Department of Cardiology,Xuhui District Central Hospital,Shanghai 200031,China)

机构地区：[1]上海市徐汇区中心医院心内科,200031

出　　处：《临床内科杂志》2018年第12期821-824,共4页Journal of Clinical Internal Medicine

摘　　要：目的探讨不同经皮冠状动脉介入治疗术(PCI)支架植入时机对急性ST段抬高型心肌梗死(STEMI)疗效和预后的影响。方法根据支架植入时机,将186例行PCI的急性STEMI患者分为A组127例和B组59例,其中A组在接受经皮冠状动脉球囊扩张术(PTCA)开通罪犯血管(IRA)后,即刻植入支架;B组在接受PTCA开通IRA后,积极给予抗栓治疗,患者病情稳定后复查冠状动脉造影且靶病变狭窄>50%,延迟植入支架。比较两组患者的支架植入情况、术后效果及预后。结果B组复查冠状动脉造影未见靶血管闭塞患者,发现8例患者的靶血管狭窄≤50%,免于延迟植入支架,最终B组51例患者纳入研究。B组患者植入支架数量少于A组,植入支架长度短于A组(P<0.05)。B组术后1 h内ST段回落、心肌梗死溶栓试验(TIMI)血流分级3级、心肌染色分级(MBG)3级患者比例均高于A组,慢血流/无复流和远端栓塞患者比例均低于A组(P<0.05)。B组围手术期出现主要不良心脏事件(MACE)患者比例低于A组(P<0.05),而两组间出现靶血管再次血运重建(TVR)、严重出血、再次心肌梗死和穿刺部位并发症患者比例比较,差异均无统计学意义(P>0.05)。结论在PTCA开通急性STEMI患者IRA后,延迟植入支架较即刻植入支架明显改善心肌血流动力学,减少MACE的发生,可能使患者获益更多。Objective To explore the effect of different stent implantation time for percutaneous coronary intervention(PCI)on efficacy and prognosis of acute ST-segment elevation myocardial infarction (STEMI).Methods A total of 186 patients with acute STEMI undergoing PCI were divided into group A (127 cases)and group B(59 cases)according to stent implantation time.Patients in group A were received immediate stent implantation after percutaneous transluminal coronary angioplasty (PTCA)openning culprit vessel(IRA),while patients in group B received PTCA openning IRA at first,then antithrombotic therapies were conducted positively.After patients turned to stable condition,coronary angiography was conducted and patients with target lesion stenosis >50%were given delayed stent implantation.Stent implantation condition ,postoperative effect and prognosis between two groups were compared.Results There were no patients with target vessels occlusion and 8 patients with target vessels stenosis ≤50% which avoided stent implantation when coronary angiography was conducted for the reexamination in group B.There were 51 patients included in group B finally.The number of implanted stents in group B was less than that in group A,and the length of implanted stentts was shorter than that in group A (P <0.05).Ratios of patients with ST segment regression within 1 h,myocardial infarction thrombolysis (TIMI)blood flow grading grade 3 and myocardial blush grading(MBG)grade 3 in group B were all higher than those in group A,while ratios of patients with slow blood flow/no reflow and distal embolization were lower than those in group A (P <0.05).Ratio of patients which suffered major adverse cardiac events (MACE)during perioperative period was lower than that in group A(P <0.05),but there were no significant differences in ratios of patients which suffered revascularization(TVR),severe hemorrhage,re-myocardial infarction and complications of puncture position between two groups(P >0.05).Conclusion After PTCA has opened IRA in patients with acut

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗术 支架植入 即刻 延迟 

分 类 号：R542.22[医药卫生—心血管疾病]