Ugalde Héctor, Ugalde Diego, Muñoz Macarena
Departamento Cardiología, Hospital Clínico, Universidad de Chile, Chile.
Rev Med Chil. 2011 Nov;139(11):1396-402. Epub 2012 Feb 8.
Primary angioplasty is superior to intravenous thrombolysis as reperfusion therapy for acute myocardial infarction.
To compare the results of available reperfusion strategies for initial management of acute myocardial infarction during hospitalization and 5 years follow up.
Historical cohort study from a prospective registry of patients admitted with acute myocardial infarction to our center. Patients treated with primary angioplasty were identified and were then matched by age, sex and date of event with patients treated with throm-bolysis. The clinical outcomes were compared including hospitalization and 5-years follow-up.
From March 1993 to August 2001, 98 patients were treated with primary angioplasty and matched with 98 thrombolyzed patients. The groups were comparable. Compared to thrombolysis, angioplasty had a higher success rate (68 and 91% respectively), resulted in less complications and reduced mortality (11 and 2% respectively), required less revascularization procedures and shorter hospital stay (17 and 13 days, respectively). During the follow-up of survivors, no differences in events or additional mortality were detected at 1 or 5 years.
Primary angioplasty is superior as treatment in terms of achieving success and reducing mortality during hospitalization. Evolution after hospitalization is independent of initial therapy.
作为急性心肌梗死的再灌注治疗方法，直接血管成形术优于静脉溶栓治疗。
比较急性心肌梗死住院期间初始治疗及5年随访中现有再灌注策略的结果。
对我院中心收治的急性心肌梗死患者前瞻性登记资料进行历史性队列研究。确定接受直接血管成形术治疗的患者，然后按年龄、性别和发病日期与接受溶栓治疗的患者进行匹配。比较临床结局，包括住院情况和5年随访情况。
1993年3月至2001年8月，98例患者接受了直接血管成形术，并与98例溶栓患者进行匹配。两组具有可比性。与溶栓治疗相比，血管成形术成功率更高（分别为68%和91%），并发症更少，死亡率更低（分别为11%和2%），需要的血管重建手术更少，住院时间更短（分别为17天和13天）。在幸存者随访期间，1年或5年时未发现事件或额外死亡率有差异。
就住院期间获得成功及降低死亡率而言，直接血管成形术作为治疗方法更具优势。住院后的病情演变与初始治疗无关。
