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目的研究梗死前心绞痛对接受PCI治疗急性心梗患者临床预后的影响。方法回顾分析122例首次发生的急性心肌梗死患者。所有患者在发病12h内进行PCI,按梗死前48h有无心绞痛分为2组,即缺血预适应组(56例)和非缺血预适应组(66例)。比较两组患者梗死相关血管PCI后血流TIMI分级、再灌注心律失常情况、心肌酶峰值浓度及出院前心脏事件发生率。结果缺血预适应组患者年龄高于非缺血预适应组(66±12比61±12,P=0.05)。非ST段抬高心肌梗死患者数量缺血预适应组明显多于非缺血预适应组,分别为30.4%和12.1%(P=0.01)。PCI后梗死相关血管无复流发生率在缺血预适应组明显低于非缺血预适应组,分别为4%和15%(P=0.03)。缺血预适应组心肌损伤标志物峰值浓度较非缺血预适应组显著降低,重度左室功能不全(LVEF<40%)发生率在缺血预适应组明显低于非缺血预适应组,分别为4%和15%(P=0.03)。结论缺血预适应组急性心梗患者PCI术后心肌酶峰值明显降低,以及梗死相关血管无复流发生率和重度左室功能不全患者比例明显降低,表明缺血预适应对急性心梗患者心脏具有保护作用,改善预后。
Objective To study the influence of pre-infarction angina on the clinical prognosis of patients with acute myocardial infarction undergoing PCI. Methods A retrospective analysis of 122 patients with acute myocardial infarction occurred for the first time. All patients underwent PCI within 12 hours of onset, and were divided into 2 groups according to their angina pectoris at 48 hours before infarction: ischemic preconditioning group (56 cases) and non-ischemic preconditioning group (66 cases). TIMI grading, reperfusion arrhythmia, peak myocardial enzyme concentration and the incidence of cardiac events before discharge were compared between the two groups. Results The age of ischemic preconditioning group was higher than that of non-ischemic preconditioning group (66 ± 12 vs 61 ± 12, P = 0.05). The number of patients with non-ST elevation myocardial infarction was significantly higher in the ischemic preconditioning group than in the non-ischemic preconditioning group, with 30.4% and 12.1%, respectively (P = 0.01). The incidence of infarction-related no-reflow after PCI was significantly lower in the ischemic preconditioning group than in the non-ischemic preconditioning group, at 4% and 15%, respectively (P = 0.03). The peak value of myocardial injury markers in ischemic preconditioning group was significantly lower than that in non-ischemic preconditioning group. The incidence of severe left ventricular dysfunction (LVEF <40%) in ischemic preconditioning group was significantly lower than that in non-ischemic preconditioning group, 4% and 15% respectively (P = 0.03). Conclusion The ischemic preconditioning group of patients with acute myocardial infarction peak myocardial enzyme activity decreased significantly, and the incidence of infarction-related vascular no-reflow and severe left ventricular dysfunction was significantly reduced, indicating that ischemic preconditioning in patients with acute myocardial infarction heart Has a protective effect, improve the prognosis.