急性心肌梗死患者初期支架植入和rt-PA静脉溶栓加补救支架植入对比研究Primary intracoronary stenting in comparison with intravenous rt-PA thrombolysis plus rescue intracoronary stenting in patients with acute myocardial infarction
张大东,蔡煦,张瑞岩,张建盛,沈卫峰
摘要(Abstract)：
目的 比较急性心肌梗死 (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血流分级法判断梗死相关冠状动脉 (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 ,并减少患者住院期心功能减退
关键词(KeyWords)： 心肌梗死;支架术;溶栓疗法
基金项目(Foundation):
作者(Author): 张大东,蔡煦,张瑞岩,张建盛,沈卫峰
参考文献(References)：
- 1CannonCP .Timetotreamentofacutemyocardialinfarctionrevisited.CurrOpinCardiol,1998,13:254266.
- 2OverliePA .Stentsinacutemyocardialinfarction.CurrOpinCardiol,1998,13:280288.
- 3GibsonCM ,CannonCP ,DaleyWL ,etal.TIMIframecount.Aquantitativemethodofassessingcoronaryarteryflow.Circulation,1996,93:879888.
- 4GarciaCantuE ,SpauldingC ,CorcosT ,etal.Stentimplantationinacutemyocardialinfarction.AmJCardiol,1996,77:451454.
- 5RodriguezAE ,FernandezM ,SantaeraO ,etal.Coronarystentinginpatientsundergoingpercutaneoustransluminalcoronaryangioplastyduringacutemyocardialinfarction.AmJCardiol,1996,77:686689.
- 6StoneGW ,BrodieBR ,GriffinJJ,etal.Prospecivemuticenterstudyofthesafetyandfeasibilityofprimarystentinginacutemyocardialinfarction:in hospitaland30 dayresultsofthePAMIstentpilottrial.JAmCollCardiol,1998,31:2330.
- 7SpauldingC ,CadorR ,BenhamdaK ,etal.One weekandsix monthangiographiccontrolsofstentimplantationafterocclusiveandnonocclusivedissectionduringprimaryballoonangioplastyforacutemyocardialinfarion.AmJCardiol,1997,79:15921595.
- 8FlachskampfFA ,EllisSG .Rescuepercutaneoustranslumminalcoronaryangioplasty.CurrOpinCardiol,1998,13:289293