【摘要】 目的 通过^99mTc-MIBI心肌灌注显像（SPECT）结合超声心动图的方法,对比评价经桡动脉入径直接经皮冠状动脉介入治疗（PCI）和溶栓后早期PCI对老年急性心肌梗死（AMI）患者的心肌灌注及心室重构的影响。方法 选择年龄>60岁的首次急性前壁心肌梗死患者172例,根据患者先前是否接受静脉溶栓治疗将患者分为溶栓后早期PCI组（E-PCI,56例）和直接PCI组（P-PCI,116例）。两组患者于AMI后1周、28周分别行超声心动图,测定左室心肌重量指数（LVMWI）,于AMI后1周时行静息及硝酸甘油介入^99mTc-MIBI SPECT,以极坐标靶心图定量法测定缺血范围记分（ES）和缺血程度记分（SS）。随访28周内主要恶性心脏事件（MACE）的发生率。结果 ①两组患者在一般临床资料方面差异均无统计学意义。②P-PCI组在PCI前冠状动脉造影（CAG）所示梗死相关动脉（IRA）开通率明显低于E-PCI组（8.62%vS 30.36%,χ²=11.16,P<0.01）。E-PCI组术后IRA血流TIMI-3级率高于P-PCI组（98.21%vs 88.76%,χ²=4.38;P<0.05）。③AMI后1周,硝酸甘油介入后^99mTc-MIBI SPECT示,E-PCI组ES、SS均较P-PCI组降低[（0.31±0.07）vs（0.52±0.10）,（118±26）vs（153±23）,P均<0.05]。④AMI后28周时E-PCI组与P-PCI组比较LVMWI明显降低[（105±46）vs（128±33）,P<0.05]。⑤随访28周E-PCI组和P-PCI组间主要脏器大出血和颅内出血的发生率差异无统计学意义,两组间MACE比较差异无统计学意义。结论 经桡动脉入径溶栓后早期PCI治疗可充分、持久地开通IRA,能在早期增加心肌灌注,阻抑AMI急性左室重构过程,其效应优于直接PCI治疗。更多还原

【Abstract】 Objective To evaluate the influence on myocardial perfusion ventricular remodeling using primary percutaneous coronary intervention（PCI） and early PCI following thrombolysis via transradial approach therapy in older patients with acute myocardial infarction（AMI） by the ^99mTc-MIBI SPECT myocardial perfusion imaging combined with echocardiogram.Methods A total of 172patients（age > 60 years） with primary anterior AMI were enrolled in this study.There were 116 patients in primary PCI group（P- PCI） and 56 patients in early PCI following thrombolysis group（E-PCI）.At 1 week and 28 weeks after AMI,the left ventricular myocardium weight index（LVMWI） was measured by echocardiogram,while the parameters of ischemic extent score（ES） and severity score（SS） were measured by rest and nitroglycerin interventional ^99mTc- MIBI SPECT to identify the viable myocardium size 1 week after PCI.Major adverse cardiac events（MACE） such as post-AMI angina,recurrence MI or mortality were recorded during 28 weeks follow- up.Results ① There were no significant differences between the two groups in clinical characteristics.②The coronary angiography showed that the TIMI- 3 grade of infarction- related artery（IRA） in E- PCI group was markedly higher than that in P- PCI group（30.36%vs 8.62%,x² = 11.16,P < 0.01）.The TIMI- 3 grade rate of IRA post- PCI in E- PCI group was higher than that in P- PCI group（98.21%vs 88.76%,x²=4.38,P < 0.05）.③At 28 weeks post- AMI,the values of ES and SS in E- PCI group were markedly decreased compared with those in P- PCI group after nitroglycerin interventional ^99mTc- MIBI SPECT[（0.31±0.07）vs（0.52 ±0.10）,（118 ±26） vs（153 ±23）,P<0.05,respectively].④At28 weeks,LVMWI in E- PCI group was significantly decreased as compared with P- PCI group[（105 ± 46） vs（128 ± 33）,P < 0.05].⑤There were no significant differences between the E- PCI group and P- PCI group in complication and MACE rates.Conclusion The early PCI following thrombolysis via transradial approach therapy might significantly increase the viable myocardium size and inhibit left ventricular remodeling by the persistent repatency of IRA,which is superiority to the primary PCI therapy.更多还原