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目的:探讨在海拔2260m地区进行急诊经皮冠状动脉介入术(PCI)在急性心肌梗死(AMI)的住院及近期临床疗效。方法:收集青海省心脑血管病专科医院心内科2005年1月至2010年10月住院患者中符合急性ST段抬高的心肌梗死病例共111例。分为急性PCI治疗组和药物溶栓组两组。治疗后观察随访一年内心血管不良事件。结果:随访30d,急诊PCI组与溶栓组对比心功能Killip分级Ⅲ～Ⅳ1.6%vs12.2%(P<0.05),复发心绞痛3.2%vs16.3%(P<0.05),而随访1年,急诊PCI组发生心功能Killip分级Ⅲ～Ⅳ、复发心绞痛依然显著低于溶栓成功组,且心源性猝死的发病显著低于溶栓成功组3.2%vs22.5%(P<0.001)。1年病死率研究发现发病后2h内溶栓成功组病死率为9%,急诊PCI病死率6.5%,死亡风险降低27.8%。发病6h内溶栓成功病死率15.5%。急诊PCI的病死率为8.9%。死亡风险降低11.5%。结论:AMI患者血管再通急诊PCI效果优于药物溶栓,在有条件的医院,应把PCI作为救治急性心肌梗死的首选。
Objective: To investigate the hospitalization and immediate clinical efficacy of emergency percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) at an altitude of 2260m. Methods: A total of 111 cases of acute myocardial infarction with acute ST-segment elevation in hospitalized patients from January 2005 to October 2010 in Department of Cardiology, Cardiovascular and Cardiovascular Hospital of Qinghai Province were collected. Divided into acute PCI treatment group and drug thrombolysis group two groups. After treatment, cardiovascular adverse events were observed within one year of follow-up. Results: After 30 days of follow-up, Killip grading Ⅲ ~ Ⅳ1.6% vs12.2% (P <0.05), angina pectoris 3.2% vs16.3% (P0.05) The incidence of cardiac function Killip grade Ⅲ ~ Ⅳ, emergency angina pectoris in emergency PCI group was still significantly lower than that of thrombolytic success group, and the incidence of sudden cardiac death was significantly lower than that of the successful thrombolytic group (3.2% vs22.5%, P <0.001) . The 1-year mortality study found that within 2 hours after onset of thrombolysis in the successful group mortality was 9%, emergency PCI mortality was 6.5%, the risk of death decreased 27.8%. The incidence of successful thrombolysis within 6h 15.5% mortality. Emergency PCI mortality was 8.9%. Risk of death reduced by 11.5%. Conclusions: PCI in AMI patients is better than drug thrombolysis in emergency revascularization. PCI should be the first choice for the treatment of acute myocardial infarction in hospitals with conditions.