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目的探讨急性心肌梗死(AMI)前心绞痛对直接经皮冠状动脉介入治疗(PCI)疗效的影响。方法将255例直接PCI术后的AMI患者根据有、无梗死前心绞痛分为梗死前心绞痛组(A组,124例)和无梗死前心绞痛组(B组,131例),比较两组一般临床特征、心功能及随访心血管事件的发生率。结果①A组磷酸肌酸激酶 (CPK)峰值、再灌注性心律失常及无复流(NF)发生率显著低于B组(P<0．05),而自溶现象发生率显著高于B 组(P<0．05)。②A组随访时期的左室舒张末期容积(LVEDV)及左室收缩末期容积(LVESV)显著低于住院期间(P<0．05),左室射血分数(LVEF)增加(P<0．05);而B组的差异均无显著性。③A组在住院期间和随访期间的心力衰竭(8．06％)和复合终点事件发生率(20．16％)显著低于B组(分别为16．79％和35．11％,P< 0．05),两组在死亡率及不稳定性心绞痛、缺血性靶血管重建、再次心肌梗死发生率方面的差异无显著性。结论直接PCI对所有AMI均有一定疗效,但存在梗死前心绞痛可促进AMI患者梗死相关动脉自溶现象的产生,减少再灌注性心律失常的发生,并有利于减少直接PCI术后心肌微循环损害,改善左心室重构,减少心脏事件的发生。
Objective To investigate the effect of angina pectoris before acute myocardial infarction (AMI) on percutaneous coronary intervention (PCI). Methods 255 patients with AMI after direct PCI were divided into pre-infarction angina group (group A, n = 124) and non-infarcted angina group (group B, n = 131) Characteristics, cardiac function and follow-up incidence of cardiovascular events. Results ① The peak of creatine phosphokinase (CPK), the rate of reperfusion arrhythmia and no-reflow (NF) in group A were significantly lower than those in group B (P <0.05), but the incidence of autolysis was significantly higher than that in group B (P <0.05). ② LVEDV and LVESV in group A were significantly lower than those in hospital (P <0.05) and LVEF ); While there was no significant difference in group B ③ The incidence of heart failure (8.06%) and composite end point (20.16%) in group A during hospitalization and follow-up were significantly lower than those in group B (16.79% and 35.11%, P <0 .05). There was no significant difference between the two groups in mortality and unstable angina, ischemic target vessel revascularization and incidence of recurrent myocardial infarction. Conclusions Direct PCI is effective in all AMI patients. However, the presence of pre-infarction angina can promote infarction-related arterial autolysis in AMI patients, reduce the incidence of reperfusion arrhythmias, and reduce the damage of myocardial microcirculation after direct PCI , Improve left ventricular remodeling, reduce the incidence of cardiac events.