论文部分内容阅读
目的:比较易化PCI(即溶栓后即刻PCI)与直接PCI对老年急性ST段抬高型心肌梗死(STEMI)术后心室重构与心功能影响。方法:回顾性分析2012-06-2015-03达州市中心医院收治的163例行PCI治疗的老年STEMI病历资料,其中易化PCI 85例(A组)、直接PCI 78例(B组),比较2组PCI治疗前后血管再通比例、左室射血分数(LVEF)%、峰射血率(PER)、峰充盈率(PFR)、左室收缩末期容积指数(LVESVI)、左室舒张期末容积指数(LVEDVI)、N-末端脑钠肽前体(NT-proBNP)与金属基质蛋白酶-9(MMP-9)。结果:首次冠脉造影显示A组PCI术前IRA再通比例显著高于B组(P<0.05);2组支架成功植入率与支架植入后血管再通比例差异均无统计学意义。2组术后各有1例死于左心衰。2组术后14dLVEF、PER、PFR、LVESVI、LVSF等均较治疗前显著改善,A组术后LVEF显著高于B组(P<0.05),其余术后14d超声心动图指标组间差异均无统计学意义。2组术后NT-proBNP、MMP-9均较治疗前显著下降(P<0.05),术后差异均无统计学意义。结论:对老年STEMI行易化PCI较直接PCI可以提高支架植入前血管再通率与术后射血功能,短期内两种介入方案对AMI患者左室重构的影响相近。
Objective: To compare the effects of facilitated PCI (immediate PCI) and direct PCI on postoperative ventricular remodeling and cardiac function in elderly patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: A retrospective analysis was performed on 163 STEMI medical records of 163 elderly patients admitted to Dazhou Central Hospital during 2012-06-2015-03. There were 85 patients (group A) with facilitated PCI and 78 patients (group B) with direct PCI The ratio of revascularization, left ventricular ejection fraction (LVEF), peak ejection rate (PER), peak parenchymal rate (PFR), left ventricular end-systolic volume index (LVESVI) (LVEDVI), NT-proBNP and MMP-9. Results: The first coronary angiography showed that the ratio of IRA recanalization before PCI in group A was significantly higher than that in group B (P <0.05). There was no significant difference in the rate of successful recanalization between two groups and the rate of recanalization after stent implantation. One patient in each group died of left heart failure after operation. The LVEF, PER, PFR, LVESVI and LVSF in the two groups after operation were significantly improved compared with those before treatment. The LVEF in group A was significantly higher than that in group B after operation (P <0.05), while the remaining 14 days after operation showed no difference in echocardiography Statistical significance. The postoperative NT-proBNP and MMP-9 levels in both groups were significantly lower than those before treatment (P <0.05), but there was no significant difference after operation. CONCLUSIONS: Elderly STEMI-facilitated PCI is more effective than PCI in improving the rate of revascularization and postoperative ejection function before stent implantation. Short-term intervention with both interventions has similar effects on left ventricular remodeling in patients with AMI.