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目的 比较直接冠状动脉支架术与加速性rt -PA静脉溶栓治疗急性ST段抬高性心肌梗死的近期临床效果。方法 168例STEMI患者中 ,10 0例行冠状动脉支架置入术 ,68例行rt-PA静脉溶栓治疗。观察两组梗死相关动脉(IRA)再通率、3 0天病死率 ,靶病变血管重建治疗等指标。结果 ①直接支架组 :在 99例病人植入 13 5个支架 ,成功率为99% ,93例IRA达TIMI血流 3级 ,7例 (7% )IRA达到TIMI血流 2级 ,3 0天病死率 2 % ;②rt -PA溶栓组 :68例IRA再通 5 9例 ,成功率 86 8% ,3 0天病死率 5 9% ,溶栓后 2～ 4周 ,5 2例做冠状动脉造影 ,均有IRA高度狭窄。结论 与rt-PA溶栓比较 ,直接冠状动脉支架术扩大了STEMI病人的治疗适应症 ,能建立可靠的IRA前向血流 ,手术并发症和病死率均低。
Objective To compare the short-term clinical effects of direct coronary stenting and accelerated rt-PA intravenous thrombolysis in the treatment of acute ST-segment elevation myocardial infarction. Methods 168 cases of STEMI patients, 10 cases of coronary stent implantation, 68 cases of rt-PA intravenous thrombolytic therapy. The relapse rate of infarction-related artery (IRA), mortality of 30 days and target vessel revascularization were observed. Results ① In the direct stent group, the stent implantation rate was 99% in 99 patients, 93 patients achieved grade 3 IRI with TIMI flow, 7 patients (7%) achieved TIMI flow grade 2 and 30 days The mortality rate was 2%. ②rt-PA thrombolysis group: 68 cases of IRA recanalization 59 cases, the success rate of 86.8%, 30 days mortality 59%, 2 to 4 weeks after thrombolysis, 52 cases of coronary artery Angiography, are highly IRA narrow. Conclusions Compared with rt-PA thrombolysis, direct coronary stenting expands the therapeutic indications for STEMI patients and establishes a reliable pre-IRA blood flow with low complications and mortality.