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目的探讨延迟和急诊经皮冠状动脉介人治疗(PCI)对ST段抬高性心肌梗死(STEMI)患者的疗效及安全性。方法48例STEMI患者,延迟PCI20例,急诊PCI28例。观察PCI术中球囊、置入支架参数及介入时间,术后TIMI血流分级、无复流现象的发生率、室性心律失常的发生率、心功能的影响以及住院期间PCI临床成功率和主要心脏不良事件(MACE,包括死亡、急性心肌梗死、再次血管重建术)发生率。结果48例患者处理病变50处,共置入55枚支架,其中药物支架(DES)46枚。临床总成功率为89.6%,急诊PCI为82.1%,延迟PCI为100%。住院期间死亡率为6.2%。与急诊PCI比较,延迟PCI选用支架长度增加(27.10±4.10%和23.00±5.86,P<0.01),减少室性心律失常的发生(10%和42.8%,P<0.05),能够恢复TIMI血流3级(100%和85.7%),无复流现象减少(0和10.7%),能改善心功能(53.4±4.2和54.7±6.3)以及减少住院期间MACE事件发生(0和17.8%,P>0.05)。结论选择最佳时期行延迟PCI开通梗死相关血管是安全可行的。但DES时代晚期开通梗死相关动脉(IRA)的远期结果尚待进一步的临床研究。
Objective To investigate the efficacy and safety of delayed and emergency percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Methods 48 cases of STEMI patients, delayed PCI20 cases, emergency PCI28 cases. The duration of PCI, the duration of postoperative TIMI flow, the incidence of no-reflow phenomenon, the incidence of ventricular arrhythmia, cardiac function and the clinical success rate of PCI during hospitalization were observed The incidence of major cardiac adverse events (MACE, including death, acute myocardial infarction, revascularization). Results Forty-eight patients were treated with 50 lesions and 55 scaffolds were included, of which 46 were DES. The clinical assembly rate was 89.6%, emergency PCI was 82.1% and delayed PCI was 100%. The in-hospital mortality rate was 6.2%. Compared with emergency PCI, delayed stent thrombosis increased (27.10 ± 4.10% vs 23.00 ± 5.86, P <0.01) and decreased ventricular arrhythmia (10% vs 42.8%, P <0.05) Grade 3 (100% and 85.7%), no-reflow reduction (0 and 10.7%), improved cardiac function (53.4 ± 4.2 and 54.7 ± 6.3), and decreased MACE events during hospitalization (0 and 17.8%, P> 0.05). Conclusion It is safe and feasible to select the best time to open the infarct-related blood vessels with delayed PCI. However, the long-term results of the opening of infarct-related artery (IRA) in the late DES era have yet to be further studied.