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目的:通过不同时段再灌注对急性ST段抬高型心肌梗死(ASTEMI)患者出院12个月随访,探讨不同时段再灌注方法对ASTEMI的终点事件、心功能预后的影响。方法:选择2006年1月~2008年1月,我科住院ASTEMI患者238例。根据是否接受冠状动脉介入治疗(PCI)及心肌再灌注时间分为3组:急诊PCI组(胸痛<12 h)89例;晚期PCI组(胸痛>24 h)86例;保守组(胸痛>24 h)63例。分别记录3组的临床资料,出院后12个月进行电话随访,预约心动超声检查。结果:①3组出院12个月主要终点事件心源性死亡率有显著性差异(P<0.05),次要终点事件心肌梗死、心力衰竭再入院率均有显著性差异(P<0.05)。②出院12个月急诊PCI组较晚期PCI组心功能的左室射血分数(LVEF)显著增加、左室舒张末内径(LVEDD)显著缩小,急诊PCI组vs.保守治疗组LVEF、LVEDD均有显著性差异(P<0.05)。结论:在降低终点事件,提高心功能方面,急诊PCI预后优于晚期PCI,晚期PCI优于保守治疗。
Objective: To investigate the effect of reperfusion at different periods on the outcome of ASTEMI and the prognosis of cardiac function in patients with acute ST-segment elevation myocardial infarction (ASTEMI) after 12-month follow-up. Methods: From January 2006 to January 2008, 238 inpatients with ASTEMI in our department were selected. The patients in the PCI group (chest pain <24 h) were enrolled in the study. The patients in the PCI group (n = 89) underwent PCI and myocardial reperfusion h) 63 cases. The clinical data of 3 groups were recorded respectively. Telephone follow-up was performed 12 months after discharge, and echocardiography was reserved. Results: There was significant difference (P <0.05) in the cardiac end-point mortality in the three groups at 12 months after discharge. There were significant differences in the rates of myocardial infarction and heart failure readmission in the secondary end points (P <0.05). ② The left ventricular ejection fraction (LVEF) and the left ventricular end diastolic diameter (LVEDD) in the PCI group were significantly lower than those in the PCI group at 12 months after discharge. The LVEF and LVEDD in the emergency PCI group and the conservative treatment group were Significant difference (P <0.05). Conclusion: The prognosis of emergency PCI is better than that of advanced PCI in reducing the end point and improving cardiac function. Late PCI is superior to conservative treatment.