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目的探讨应用药物洗脱支架(DES)治疗ST段抬高型急性心肌梗死(STEMI)急性闭塞病变的近期临床疗效。方法对2005年1月至2006年9月164例STEMI患者行直接冠状动脉介入治疗手术(直接PCI),并将患者分为两组。应用DES治疗STEMI急性闭塞病例79例(DES组),应用普通金属裸支架(BMS)治疗STEMI急性闭塞病例85例(BMS组,对照组)。观察两组直接PCI术后即刻成功率、术后TIMI血流、心电图ST段回落情况,心绞痛改善情况,心肌损伤标志物即磷酸肌酸激酶-同功酶(CK-MB)峰值,住院期间主要不良心脏事件(MACE)发生率,住院时间及出院前左室射血分数(LVEF)。结果DES组、对照组直接PCI术后即刻成功率分别为99.1%、98.8%,术后TIMI血流Ⅱ~Ⅲ级分别为96.2%、95.2%,术后2 h心电图ST段回落≥50%分别为67.09%、64.71%,术后心绞痛明显改善率分别为81.01%、82.35%,CK-MB峰值分别为(16±3)h、(17±4)h,住院期间MACE发生率分别为0、1.2%,平均住院时间分别为(7.2±2.7)d,(7.4±2.8)d,出院前LVEF分别为(50±9)%、(53±10)%。以上各项指标两组比较差异均无统计学意义。结论急性ST段抬高型心肌梗死急性闭塞病变行直接PCI治疗时置入药物洗脱支架即刻成功率高,近期临床疗效显著、安全。
Objective To investigate the short-term clinical efficacy of drug-eluting stent (DES) in the treatment of acute occlusive ST-segment elevation acute myocardial infarction (STEMI). Methods A total of 164 STEMI patients underwent PCI during January 2005 to September 2006. The patients were divided into two groups. A total of 79 acute STEMI occlusion cases (DES group) were treated with DES and 85 cases of STEMI acute occlusion group (BMS group and control group) were treated with bare metal stent (BMS). The success rate of immediate postoperative PCI, the postoperative TIMI blood flow, ST-segment depression, the improvement of angina pectoris, the peak value of myocardial creatine kinase (CK-MB) and the peak value of CK-MB during hospitalization The incidence of adverse cardiac events (MACE), length of stay, and left ventricular ejection fraction (LVEF) before discharge. Results The success rates of immediate PCI in DES group and control group immediately after PCI were 99.1% and 98.8% respectively. The postoperative TIMI blood flow grades Ⅱ ~ Ⅲ were 96.2% and 95.2% (16 ± 3) h, (17 ± 4) h respectively. The incidences of MACE during hospitalization were 0, 0 and 0, respectively. The mean improvement rate of postoperative angina was 81.01% and 82.35% The average length of hospital stay was (7.2 ± 2.7) days and (7.4 ± 2.8) days respectively. The LVEF before discharge was (50 ± 9)% and (53 ± 10)% respectively. The above indicators were no significant difference between the two groups. Conclusions Immediate acute ST-segment elevation myocardial infarction with immediate occlusion undergoing direct PCI has a high success rate of immediate placement into drug-eluting stents. The clinical outcome is significant and safe in the near future.