急性ST段抬高型心肌梗死溶栓成功患者行经皮冠状动脉介入治疗的随机对照研究  

Efficacy of percutaneous coronary intervention on patients with acute myocardial infarction after successful thrombolysis: a randomized controlled study

作　　者：陈新东[1] 朱志军[1] 黄彦真 陈永辉[1] 陈竹君[2] 魏水生[2] 

机构地区：[1]陆丰县人民医院心内科,广东汕尾516500 [2]广东省心血管病研究所心内科广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2016年第5期535-539,共5页South China Journal of Cardiovascular Diseases

基　　金：广东省卫生厅立项(编号:WSTJJ2011110844253019 6308200217)

摘　　要：目的 观察急性ST段抬高型心肌梗死（ST-elevation acute myocardial infarction,STEMI）溶栓成功患者短期内接受经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗2年的临床疗效。方法 入选溶栓成功的STEMI患者252例,其中男189例（75%）,女63例（25%）,年龄（61.5±9.9）岁。入选患者按随机数字表法分为保守治疗组（125例）和PCI治疗组（127例）。患者于基线和随访1年时检测氨基末端脑钠肽前体（Nterminal pro-brain natriuretic peptide,NT-pro BNP）浓度并行超声心动图检查测量左心室射血分数（left ventricular ejection fraction,LVEF）;观察终点为主要不良心血管事件（major adverse cardiovascular events,MACE）,最长随访2年。结果 两组基线NT-pro BNP浓度和LVEF比较,差异无统计学意义（P〉0.05）。1年时的随访发现,与保守治疗组相比较,PCI治疗组LVEF显著升高、NT-pro BNP浓度显著下降,差异有统计学意义（P〈0.05;P〈0.01）。在2年的随访中,与保守治疗组相比较,PCI治疗组的2年MACE发生率明显降低（16.5%vs.25.6%,Log-rank,P=0.027）;与单纯保守治疗相比,联合PCI治疗可以使患者的2年MACE发生风险降低25%（校正HR=0.67,95%CI：0.49~0.92,P=0.037）。结论 对于溶栓成功的STEMI患者,与单纯保守治疗相比较,联合采用PCI治疗可以明显改善患者的左心室收缩功能并能显著降低患者的2年MACE发生风险。Objectives To compare the 2-year efficacy of percutaneous coronary intervention （PCI） after successful thrombolysis in patients with ST-elevation acute myocardial infarction （STEMI）. Methods Totally 252 patients who were successfully performed thrombolysis with STEMI were selected in this study. After successful thrombolysis, patients were randomly divided into conservative treatment group （125 cases） and PCI group （127 cases）. Concentration of N- terminal pro-brain natriuretic peptide （NT-proBNP） and left ventricular ejection fraction （LVEF） were tested at baseline and at one-year follow-up. Clinical endpoint was cumulative incidence of major adverse cardiovascular events （MACE）. Results There was no statistically difference for concentration of NT-proBNP and LVEF at baseline between the two groups （P〉0.05）. However, at one-year follow-up, concentration of NT-proBNP in PCI group significantly decreased （P〈0.05） and LVEF in PCI group significantly increased （P〈0.01） when compared to those in conservative treatment group. During 2-years follow-up, there was a lower MACE incidence rate in PCI group when compared to conservative treatment group （16.5% vs. 25.6%, Log-rank, P=0.027）. Cox regression showed that PCI after successful thrombolysis was associated in with lower risk of 2-year incidence of MACE （adjusted HR=0.75 , 95%CI： 0.55- 0.92, P=0.037）. Conclusions For STEMI patients after successful thrombolysis, PCI combined with conservative treatment could improve left ventricular function and lower the risk of 2-year incidence of MACE, when compared to conservative treatment alone. events

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 溶栓 主要不良心血管事件 

分 类 号：R654.2[医药卫生—外科学]