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目的:比较不同急性ST段抬高型心肌梗死(STEMI)患者静脉溶栓治疗、溶栓成功后延迟经皮冠状动脉介入(PCI)治疗、直接PCI(PPCI)治疗的临床疗效及近期预后。方法:入选符合入组标准的218例STEMI患者。根据患者就诊时间及治疗的实际情况分组:A组即PPCI治疗(90例);B组即只进行静脉溶栓治疗(78例),将发病3 h内溶栓的患者分为B1组(30例),超过3 h分为B2组(48例);C组即溶栓成功后延迟PCI治疗组(50例)。支架及用药方法:A组、C组患者罪犯血管是PCI治疗的唯一目标,不限制支架的应用与选择。3组患者治疗方案均遵循STEMI治疗指南。随访指标:218例患者均在术后30 d接受门诊随访。比较住院和随访期间的心脏事件(MACE事件)、复合终点事件和心脏彩超[左室射血分数(LVEF)、左室舒张末径(LVEDD)]变化。结果:218例患者均进入结果分析。(1)各组患者间基线资料和临床资料比较差异均无统计学意义,各组间具有可比性;(2)随访期间MACE事件及复合终点事件发生率:A组低于B2组、C组,差异有统计学意义(P<0.05)。(3)随访期间A组LVEF高于B2组、C组,C组LVEF高于B2组;A组LVEDD低于B2组、C组,C组LVEDD低于B2组,比较差异有统计学意义(P<0.05)。结论:直接PCI是STEMI患者最有效的再灌注治疗方法;发病3 h内的患者,溶栓治疗的即刻效果及30 d预后不劣于直接PCI。溶栓治疗并不是STEMI患者的治疗终点。
Objective: To compare the clinical efficacy and short-term prognosis of intravenous thrombolysis in patients with acute ST-elevation myocardial infarction (STEMI), delayed percutaneous coronary intervention (PCI) and direct PCI (PPCI) after successful thrombolysis. Methods: A total of 218 STEMI patients were eligible. Patients in group A were treated with PPCI (n = 90). Patients in group B received intravenous thrombolysis only (n = 78), and those who thrombolysis within 3 h were divided into group B1 (n = 30) Cases) were divided into B2 group (48 cases) more than 3 hours. Group C was delayed in PCI group after thrombolysis (50 cases). Scaffolds and methods of administration: criminals in group A and group C are the only targets of PCI treatment, and their application and choice are not limited. Three groups of patients were followed STEMI treatment guidelines. Follow-up index: 218 patients were outpatient follow-up after 30 days. Cardiac events (MACE events) during hospitalization and follow-up, composite end point events, and changes in cardiac ultrasonography (left ventricular ejection fraction (LVEF), left ventricular diastolic diameter (LVEDD)) were compared. Results: All 218 patients entered the result analysis. (1) There was no significant difference between the baseline data and clinical data in each group of patients, and there was comparability among the groups. (2) The incidence of MACE events and composite end points during follow-up: A group was lower than B2 group and C group , The difference was statistically significant (P <0.05). (3) The LVEF in group A was higher than that in group B2 during the follow-up period, while the LVEF in group C and C was higher than that in group B2; LVEDD in group A was lower than that in group B2; LVEDD in group C and C was lower than that in group B2 P <0.05). Conclusions: Direct PCI is the most effective reperfusion therapy in patients with STEMI. The immediate effect of thrombolytic therapy and the 30-day prognosis are not inferior to direct PCI in patients within 3 hours of onset. Thrombolytic therapy is not the end of treatment in STEMI patients.