目的探讨急性心肌梗死患者接受不同再灌注治疗的特点及近远期疗效。方法回顾性分析2000年1月~2004年5月期间281例ST段抬高急性心肌梗死患者分别接受直接冠状动脉成形术、静脉溶栓、补救性冠状动脉成形术、冠状动脉搭桥治疗,比较接受不同再灌注治疗患者的临床特征、心肌梗死、再灌注治疗时间、冠状动脉病变特点、住院及随访期间不良心血管事件发生情况。结果接受静脉溶栓、直接冠状动脉成形术、补救性冠状动脉成形术、冠状动脉搭桥治疗患者分别为51例、182例、34例、14例,接受再灌注治疗以男性为主,常伴有糖尿病史,补救性冠状动脉成形术组年龄偏小。心肌梗死部位无差异性,发病至入院时间无差异性,入院至再灌注治疗时间有显著性差异(P<0.001)。冠状动脉造影示直接冠状动脉成形术组、补救冠状动脉成形术组、冠状动脉搭桥组梗死相关动脉分布、狭窄程度、病变类型无明显差异(P>0.05),病变血管数有明显差异(P<0.001),梗死相关动脉再通率有显著性差别(P<0.001)。住院期间仅直接冠状动脉成形术组有4例行再次血运重建,四组患者再发心绞痛发生率无差异性,但四组患者死亡率有显著性差异。21例患者失访,随访期间四组患者再发心绞痛、再发心肌梗死、病死率均无显著性差异,直接冠状动脉成形术组因支架内再狭窄分别有6例和9例进行冠状动脉搭桥术和切割球囊+支架植入术。结论对急性心肌梗死患者实施不同再灌注治疗是安全有效的,应重视对合并心源性休克患者开展直接冠状动脉成形术和急症冠状动脉搭桥术。直接冠状动脉成形术组再次血运重建率高(8.2%),应用药物洗脱支架有望进一步改善预后。 Objective To investigate the characteristics of short-term and long-term treatment of patients with acute myocardial infarction receiving different reperfusion. Methods A retrospective analysis of 281 patients with acute ST-segment elevation myocardial infarction between January 2000 and May 2004 received direct coronary angioplasty, intravenous thrombolysis, salvage coronary artery bypass grafting, and coronary artery bypass grafting different clinical features of patients with reperfusion therapy, myocardial infarction, reperfusion therapy time, the characteristics of coronary artery disease, hospitalization and adverse cardiovascular events during follow-up cases. Results The patients receiving intravenous thrombolysis, direct coronary angioplasty, salvage coronary artery bypass grafting and coronary artery bypass grafting were 51, 182, 34 and 14, respectively. The patients undergoing reperfusion therapy were mainly male and were often accompanied by Diabetes history, rescue coronary angioplasty group age is small. There was no difference in myocardial infarction sites, no difference in the time from hospitalization to admission, and there was a significant difference between admission and reperfusion (P <0.001). Coronary angiography showed no significant difference (P> 0.05) in infarction-related artery distribution, stenosis and type of lesion in direct coronary angioplasty group, reperfusion coronary artery angioplasty group and coronary artery bypass grafting group, and significant difference in vessel number of lesion (P < 0.001), there was a significant difference in the recanalization rate of infarct-related arteries (P <0.001). Only during hospitalization coronary angioplasty group 4 patients revascularization, four groups of patients with recurrent angina was no difference, but the difference in mortality significant four groups. Twenty-one patients were lost to follow-up. During the follow-up period, there was no significant difference in recurrent angina pectoris, recurrent myocardial infarction, and mortality in all patients. In the direct coronary angioplasty group, there were 6 cases with in-stent restenosis and 9 cases with coronary artery bypass graft Surgery and cutting balloon + stent implantation. Conclusion It is safe and effective to treat different kinds of reperfusion in acute myocardial infarction patients. Direct coronary angioplasty and emergency coronary artery bypass grafting should be emphasized in patients with cardiogenic shock. The rate of revascularization was high in direct coronary angioplasty (8.2%) and the use of drug-eluting stents was expected to further improve the prognosis.