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目的 探讨急性前壁心肌梗死(AMI)后延迟经皮冠状动脉介入治疗(PCI)使梗死相关动脉(IRA)开通对AMI晚期左室重构的影响。方法 选择64例急性前壁、前间壁及广泛前壁Q波性AMI后病情稳定,发病2~14天,平均(9 .1±2 .3)天冠状动脉造影证实左前降支完全闭塞者,依据是否成功行PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室大小、左室功能和室壁活动异常情况,并观察6个月期间心力衰竭事件的发生情况。结果 AMI后2个月两组左室射血分数、左室收缩末期容积指数、左室舒张末期容积指数和室壁活动异常积分与急性期相比差异无统计学意义,急性期和2个月时两组上述各指标之间差异也无统计学意义。6个月时两组左室射血分数和室壁活动异常积分与急性期和2个月相比差异无统计学意义,但对照组左室舒张末期容积指数和左室收缩末期容积指数较急性期明显增大(P<0 .01, P<0. 05 ),且与成功PCI组相比差异有统计学意义(P<0 .01, P<0 .05)。6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组为2%,但差异无统计学意义。结论 急性前壁AMI后IRA延迟开通能明显减少AMI后晚期的左室重构,而对AMI后早期左室重构的影响不大。延迟PCI可能有利于减少AMI后远期心力衰竭事件的发生。
Objective To investigate the effect of delayed percutaneous coronary intervention (PCI) on infarction-related artery (IRA) opening in patients with acute AMI after acute myocardial infarction (AMI). Methods 64 cases of acute anterior wall, anteroseptal and extensive anterior wall Q wave AMI after a stable condition, the incidence of 2 to 14 days, an average of (9 .1 ± 2.3) day coronary artery angiography confirmed the left anterior descending branch completely occluded, According to the success or failure of PCI, the patients were divided into two groups: PCI group and control group. The left ventricular size, left ventricular function and ventricular wall motion were followed up in acute phase, 2 months and 6 months respectively. The incidence of heart failure events during the month. Results There was no significant difference in left ventricular ejection fraction, left ventricular end-systolic volume index, left ventricular end-diastolic volume index and ventricular wall motion abnormality score between the two groups at 2 months after AMI and at acute stage The difference between the above two indicators was not statistically significant. At 6 months, there was no significant difference between left ventricular ejection fraction and ventricular wall motion abnormal score in both groups, but the left ventricular end-diastolic volume index and left ventricular end-systolic volume index in the control group were higher than those in the acute phase (P <0.01, P <0.05), and the difference was statistically significant compared with the successful PCI group (P <0.01, P <0.05). The incidence of heart failure events at 6 months of follow-up was 19% in the control group and 2% in the successful PCI group, but the difference was not statistically significant. Conclusion Delayed opening of IRA after acute anterior wall myocardial infarction can significantly reduce late left ventricular remodeling after AMI, but little effect on left ventricular remodeling after AMI. Delayed PCI may be helpful in reducing the occurrence of long-term heart failure events after AMI.