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目的 探讨急诊直接冠脉内支架置入术治疗ST段抬高型急性心肌梗死 (AMI)的价值。方法 ST段抬高型AMI患者 133例 ,分别行直接冠脉内支架置入术 (直接支架组 ,81例 )和球囊预扩张后支架置入术 (常规支架组 ,5 2例 )。对比两组患者的介入治疗、术后TIMI分级和心电图、出院前左室射血分数 (LVEF)和住院期间主要不良心脏事件发生率。结果 直接支架组和常规支架组基础临床特征、TIMI 3级和无复流均无统计学显著差异 (P >0 .0 5 )。直接支架组平均X线曝光时间和造影剂用量均显著低于常规支架组 (P <0 .0 5 ) ,而平均LVEF显著高于常规支架组 (P <0 .0 5 ) ,且ST段无回落的发生率和住院期间主要不良心脏事件发生率均显著降低 (P <0 .0 5 )。结论 对于ST段抬高型AMI中适当的冠状动脉病变 ,直接冠脉内支架置入术不仅可以减少X线曝光时间和造影剂用量 ,而且可能改善患者的心肌组织再灌注和近期预后。
Objective To investigate the value of emergency direct coronary stenting in the treatment of ST-segment elevation acute myocardial infarction (AMI). Methods A total of 133 patients with ST-elevation AMI were enrolled in this study. They were treated with direct coronary stent implantation (direct stent group, n = 81) and balloon dilatation and stent implantation (conventional stent group, n = 52). Interventional therapy, postoperative TIMI classification and electrocardiogram, pre-discharge left ventricular ejection fraction (LVEF), and incidence of major adverse cardiac events during hospitalization were compared between the two groups. Results The basic clinical features of direct stent group and conventional stent group showed no significant difference between TIMI grade 3 and no-reflow (P> 0.05). The average X-ray exposure time and the amount of contrast medium in the direct stent group were significantly lower than those in the conventional stent group (P <0.05), while the average LVEF was significantly higher than that in the conventional stent group (P <0.05) The incidence of depression and major adverse cardiac events during hospitalization were significantly lower (P <0.05). Conclusions For proper coronary artery disease in ST-segment elevation AMI, direct coronary stenting not only reduces X-ray exposure time and contrast media but may improve myocardial reperfusion and short-term prognosis.