冠状动脉介入治疗再灌注时间对急性前壁心肌梗死左室重构及远期预后的影响
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Effects of reperfusion-time on left ventricular remodeling and prognosis in patients with anterior acute myocardial infarction treated with percutaneous coronary intervention
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    摘要:

    目的评价冠状动脉介入治疗(PCI)再灌注时间对急性前壁心肌梗死左室重构及远期预后的影响。方法选择113例首次急性前壁心肌梗死患者,冠状动脉造影证实梗死相关动脉(IRA)完全闭塞(TIMI0~1级)。依据PCI再灌注时间分为3组,A组35例,6h内IRA成功再灌注;B组40例,6~12h内IRA成功再灌注;C组38例,12~24h内IRA成功再灌注。分别于术后即刻和6个月行冠状动脉造影及左心室造影,对比分析3组左心室造影的心功能指标:左心室舒张末容积、左心室收缩末容积、左心室射血分数、每分输出量、心脏指数,并观察1年内主要不良心脏事件(MACE)的发生情况。结果成功再灌注即刻,3组之间各项心功能参数无显著性差异。6个月时A组和B组各项心功能参数较即刻有改善趋势;C组较前下降,但均无统计学意义。1年随访期间,A、B组无死亡及再次心肌梗死事件发生。心绞痛的发生在3组中无差别。C组心力衰竭及死亡的发生均明显高于A、B组。结论前壁心肌梗死后尽早行PCI,开通IRA,可阻抑左室重构,改善心功能,减少死亡等MACE的发生,从而改善预后。

    Abstract:

    Objective To evaluate the impact of reperfusion-time on left ventricular remodeling and long-term mortality in patients with anterior acute myocardial infarction (AMI) undergoing successful primary percutaneous coronary intervention(PCI). Methods A total of 113 patients with primary anterior AMI were enrolled,in whom coronary angiography revealed a total occlusion of infarct-related artery (IRA) (TIMI 0-1). According to the reperfusion-time for PCI,the subjects were divided into three groups: group A (35 patients),the reperfusion-time <6 h; group B (40 patients),the reperfusion-time between 6 and 12 h; group C (38 patients),the reperfusion-time between 12 and 24 h. All patients underwent the coronary artery angiography and left ventricular angiography both immediately and at 6 months. The left ventricular end diastolic volume,left ventricular end systolic volume,left ventricular ejection fraction,cardiac output,and cardiac index were compared among the three groups. Main adverse cardiac events (MACE) during one year follow-up,including angina,heart failure,myocardial infarction,and cardiac death were also compared among the groups. Results There was no difference in parameters of heart function among the three groups immediately after successful reperfusion. At 6 months,the heart function in group A and B was improved,but not in group C. During one year follow up,there was no death or recurrence of myocardial infarction in group A and B. There was no difference in angina incidence among the three groups. There was higher incidence of heart failure and death in group C than in group A and B. Conclusion Early PCI in patients with anterior AMI is recommended. It can achieve IRA revascularization,prohibit left ventricular remodeling,improve heart function,and decrease incidence of MACE,thus long-term prognosis can be improved.

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XIANG XiaoJun, LV JiYuan, YE XinLong.冠状动脉介入治疗再灌注时间对急性前壁心肌梗死左室重构及远期预后的影响[J].中华老年多器官疾病杂志,2010,9(3):256~260

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