【摘要】 目的探讨不同血运重建方法对陈旧前壁心肌梗死合并左心室室壁瘤患者的左心室重塑指标、心功能以及远期预后的影响。方法共入选Euro Score评分中低危的患者223例,分为经皮冠状动脉介入治疗(PCI)组129例和冠状动脉旁路移植术(CABG)组94例。患者分别于血运重建术前、术后6个月行超声心动图检查,随访36个月记录主要终点事件(全因死亡、脑卒中、心肌梗死)及主要不良心脏事件(MACE)发生情况。结果接受血运重建术前,PCI组与CABG组患者左心室舒张末期内径(LVEDd)[(58.12±10.01)mm比(61.75±5.85)mm]、左心室射血分数(LVEF)[(43.57±9.41)%比(42.98±10.98)%]、左心室质量指数(LVMI)[(122.47±15.36)g/m2比(126.22±16.58)g/m2]比较,差异均无统计学意义(均P>0.05)。PCI组术后6个月较术前LVEDd[(52.32±4.23)mm比(58.12±10.01)mm,P<0.05]、LVEF[(56.56±9.65)%比(43.57±9.41)%,P<0.05]和LVMI[(107.54±15.25)g/m2比(122.47±15.36)g/m2,P<0.05]显著改善。CABG组术后6个月较术前LVEDd[(53.65±3.72)mm比(61.75±5.85)mm,P<0.05]、LVEF[(57.70±10.65)%比(42.98±10.98)%,P<0.05]和LVMI[(109.43±14.35)g/m2比(126.22±16.58)g/m2,P<0.05]也显著改善。累积36个月随访发现,PCI组主要终点事件和MACE发生率高于CABG组,但差异无统计学意义(13.2%比12.8%,χ2=0.29,P>0.05;12.4%比6.4%,χ2=2.22,P>0.05)。结论不同血运重建方法均显示术后6个月LVEF升高、LVMI降低,但在心功能、左心室重塑、主要终点事件以及MACE改善方面,CABG术与PCI术间差异无统计学意义。更多还原

【Abstract】 Objective The study was designed to analyze the impact of different revascularization strategies on patients who were diagnosed as old anterior myocardial infarction complicated by left ventricular aneurysm. Methods Among 223 patients with low to intermediate risk stratification of Euro SCORE system,129 underwent PCI and 94 received CABG respectively. Among all these patients,echocardiography was performed at pre-procedural and 6 months after procedure. At mean 36 months of follow-up,primary endpoints( all-cause mortality,cerebrovascular events,myocardial infarction) and major adverse cardiac events were all recorded. Results PCI and CABG showed no significant differences in LVEDd [(58. 12 ±10. 01) mm vs.(61. 75 ± 5. 85) mm],LVEF [( 43. 57 ± 9. 41) % vs.( 42. 98 ± 10. 98) % ],LVMI[(122. 47 ± 15. 36) g/m2 vs.( 126. 22 ± 16. 58) g / m2] before revascularization procedure( all P >0. 05). As compared to baseline data,LVEDd [(52. 32 ± 4. 23) mm vs.(58. 12 ± 10. 01) mm,P <0. 05],LVEF [( 56. 56 ± 9. 65) % vs.( 43. 57 ± 9. 41) %, P < 0. 05] and LVMI [( 107. 54 ±15. 25) g / m2 vs.(122. 47 ± 15. 36) g / m2,P < 0. 05] improved in the PCI group at 6 months followup. Smilar improvement found in the CABG group as compared to baseline data in LVEDd [(53. 65 ± 3. 72)mm vs.(61. 75 ± 5. 85) mm,P < 0. 05],LVEF [(57. 70 ± 10. 65) % vs.(42. 98 ± 10. 98) %,P <0. 05] and LVMI [(109. 43 ± 14. 35) g / m2 vs.(126. 22 ± 16. 58) g / m2,P < 0. 05]in 6 months follow up. Primary endpoints and MACE were higher in PCI group than in CABG group,but there was no statistical difference(13. 2% vs. 12. 8%, χ2= 0. 29, P > 0. 05; 12. 4% vs. 6. 4%, χ2= 2. 22, P > 0. 05).Conclusions The two different revascularization strategies can both improve LVEF and LVMI at 6 months follow-up. CABG was likely to be beneficial in terms of cardiac function,remodeling,primary endpoints and MACE. There were no statistical significance between PCI and CABG.更多还原