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目的 比较研究梗死相关动脉自发再通 (SR)后即刻和择期经皮冠状动脉腔内成形术的临床结果。方法 选择 1996年 1月至 2 0 0 1年 3月的 118例SR患者为研究对象 ,其中TIMI 2级血流患者 36例中 2 4例施行了即刻PTCA ,12例在梗死后 7～ 14d施行了择期PTCA ;TIMI 3级血流患者82例 ,其中 4 5例施行了即刻PTCA ,37例施行了择期PTCA。结果 发病 2周后 ,TIMI 2级血流两组的死亡率、再梗死率以及TIMI 3级血流两组的死亡率、再梗死率、复发缺血事件发生率差异无显著性 ,但TIMI 2级血流择期PTCA组的复发缺血事件发生率显著高于即刻PTCA组 (1 2 4vs 4 12 ,P =0 0 34)。此外 ,择期PTCA组肝素或低分子肝素的应用显著多于即刻PTCA组 (4 2 4vs 11 12 ,3 4 5vs34 37,P <0 0 0 1)。 6个月随访时 ,TIMI 2级血流择期PTCA组充血性心力衰竭发生率较即刻PTCA组有增高的趋势 (1 2 4vs 3 12 ,P =0 0 98) ,而且择期PTCA组的左室射血分数显著低于即刻PTCA组[(6 1 4± 6 3) %vs(4 3 8± 5 4 ) % ,P =0 0 3]。结论 发生SR的患者进行即刻PTCA的临床结果优于择期PTCA ,同时可以降低住院总费用 ,减少患者痛苦。
Objective To compare the clinical outcomes of percutaneous transluminal coronary angioplasty (PTCA) immediately and electively after infarction-related artery spontaneous recanalization (SR). Methods A total of 118 SR patients from January 1996 to March 2001 were enrolled in this study. Twenty-four of 36 patients with TIMI grade 2 blood flow performed immediate PTCA and 12 patients were administered 7 to 14 days after infarction Elective PTCA; TIMI grade 3 blood flow in 82 patients, of which 45 cases of immediate PTCA, 37 cases of elective PTCA. Results After 2 weeks of onset, there were no significant differences in the rates of death, reinfarction, and recurrent ischemic events between the two groups of TIMI grade 2 blood flow, TIMI grade 2 The incidence of recurrent ischemic events was significantly higher in the PTCA group than in the PTCA group (12 4 vs 4 12, P = 0 34). In addition, the use of heparin or low molecular weight heparin in the PTCA group was significantly more frequent than in the immediate PTCA group (4 2 4 vs 11 12, 34 5 vs 34 37, P 0 01). At 6 months of follow-up, the incidence of congestive heart failure in TIMI grade 2 PTCA patients was significantly higher than that in PTCA patients (12 4 vs 32, P = 0 988) The blood score was significantly lower than that of the immediate PTCA group [(6 1 4 ± 6 3)% vs (43 8 ± 54)%, P = 0 0 3]. Conclusions The clinical outcome of immediate PTCA in patients with SR is superior to that of elective PTCA and can reduce the total cost of hospitalization and reduce the suffering of patients.