Zhang Dadong, Cai Xu, Zhang Ruiyan, Zhang Jiansheng, Shen Weifeng
Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China.
Chin Med J (Engl). 2002 Feb;115(2):163-5.
To compare primary stenting in the infarct-related coronary artery with intravenous rt-PA therapy plus rescue intracoronary stenting.
Ninety-eight patients with a first acute myocardial infarction (AMI) were randomly treated with primary intracoronary stenting (primary stenting group) or with intravenous rt-PA therapy plus rescue intracoronary stenting (thrombolysis plus stenting group). Thrombolysis in myocardial infarction (TIMI) flow grade was assessed by angiography in emergency, and cardiac function (left ventricular ejection fraction, LVEF) was calculated by echocardiography before discharge between the two groups.
There were 47 patients (97.91%) in primary stenting group and 50 patients (100%) in thrombolysis plus stenting group had achieved TIMI grade 2 - 3 flow after the procedure. But the former had more cases (93.8%) of TIMI 3 flow than that of latter (60.0%, P = 0.0001). There was no difference between the two groups in cardiac events during hospitalization. But the patients in primary stenting group had better cardiac function (LVEF 0.62 +/- 0.14 vs. 0.50 +/- 0.12, respectively, P = 0.0001) between the two groups.
Primary intracoronary stenting may improve myocardial reperfusion in emergency and inhibit the decline of cardiac function after AMI in comparison with intravenous rt-PA thrombolysis plus rescue intracoronary stenting.
比较梗死相关冠状动脉的直接支架置入术与静脉注射rt-PA治疗加挽救性冠状动脉内支架置入术。
98例首次急性心肌梗死（AMI）患者被随机分为接受直接冠状动脉内支架置入术（直接支架置入组）或静脉注射rt-PA治疗加挽救性冠状动脉内支架置入术（溶栓加支架置入组）。在急诊时通过血管造影评估心肌梗死溶栓（TIMI）血流分级，出院前通过超声心动图计算两组的心脏功能（左心室射血分数，LVEF）。
直接支架置入组47例患者（97.91%）、溶栓加支架置入组50例患者（100%）术后达到TIMI 2-3级血流。但前者TIMI 3级血流的病例数（93.8%）多于后者（60.0%，P = 0.0001）。两组住院期间心脏事件无差异。但直接支架置入组患者心脏功能更好（LVEF分别为0.62±0.14和0.50±0.12，P = 0.0001）。
与静脉注射rt-PA溶栓加挽救性冠状动脉内支架置入术相比，直接冠状动脉内支架置入术可能改善急诊心肌再灌注并抑制AMI后心脏功能下降。
