Geng Wei, Tian Xiang, Fu Xianghua, Wang Peijun, Wang Yanbo, Wang Xuechao, Li Wei, Liu Xin
The No 1 Central Hospital of Baoding City, Baoding, China.
Coron Artery Dis. 2013 May;24(3):238-43. doi: 10.1097/MCA.0b013e32835e5c67.
The aim of this study was to evaluate the safety and feasibility of early angioplasty within 12 h and selective angioplasty 1 week later after successful thrombolysis in acute ST-segment elevation myocardial infarction.
A total of 224 patients with acute ST-segment elevation myocardial infarction who received thrombolysis with reteplase were randomly assigned to an early percutaneous coronary intervention (E-PCI) group or a selective PCI (S-PCI) group. Patients assigned to the E-PCI group received PCI within 12 h after randomization, and patients assigned to the S-PCI group received PCI 1 week later after randomization. The primary end point was a combined end point consisting of death, reinfarction, recurrent ischemia and congestive heart failure during hospitalization. The secondary end points included death, reinfarction, recurrent ischemia, and repeat PCI during 12 months of follow-up.
The baseline clinical characteristics were well balanced between the two groups. The primary end point rate was significantly higher in the S-PCI group compared with the E-PCI group (14.3 vs. 4.5%, P=0.0219). Fewer episodes of recurrent ischemia were observed in the E-PCI group compared with the S-PCI group during hospital stay (0.0 vs. 6.3%, P=0.0212). There were no significant differences in death, reinfarction, recurrent ischemia and repeat PCI between the two groups during 12 months of follow-up.
For patients presenting with an ST-segment elevation myocardial infarction who could not undergo timely primary PCI, thrombolysis followed by PCI within 12 h was a preferred reperfusion strategy and associated with a significant reduction in the recurrent ischemia during hospitalization.
本研究旨在评估急性ST段抬高型心肌梗死成功溶栓后12小时内早期血管成形术及1周后选择性血管成形术的安全性和可行性。
总共224例接受瑞替普酶溶栓治疗的急性ST段抬高型心肌梗死患者被随机分配至早期经皮冠状动脉介入治疗（E-PCI）组或选择性PCI（S-PCI）组。分配至E-PCI组的患者在随机分组后12小时内接受PCI，分配至S-PCI组的患者在随机分组1周后接受PCI。主要终点是一个综合终点，包括住院期间的死亡、再梗死、复发性缺血和充血性心力衰竭。次要终点包括随访12个月期间的死亡、再梗死、复发性缺血和重复PCI。
两组之间基线临床特征均衡良好。S-PCI组的主要终点发生率明显高于E-PCI组（14.3%对4.5%，P=0.0219）。住院期间，E-PCI组观察到的复发性缺血发作少于S-PCI组（0.0%对6.3%，P=0.0212）。随访12个月期间，两组在死亡、再梗死、复发性缺血和重复PCI方面无显著差异。
对于无法及时进行直接PCI的ST段抬高型心肌梗死患者，溶栓后12小时内进行PCI是一种首选的再灌注策略，且与住院期间复发性缺血的显著减少相关。
