溶栓后即刻PCI与直接PCI对STEMI患者术后心室重构及心功能的对比研究

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Abstract Objective To explore the effects of immediate percutaneous coronary intervention (PCI) after thrombolysis and primary PCI on postoperative ventricular remodeling and cardiac function in patients with acute ST segment elevation myocardial infarction (STEMI). Methods The clinical data of 123 patients with STEMI in Xuanwu Hospital, Capital Medical University from February 2017 to July 2019 were retrospectively analyzed, who were divided into immediate PCI group after thrombolysis (group A, n = 67) and primary PCI group (group B, n = 56) according to the surgical protocol. The indexes of ventricular remodeling and left ventricular function and the levels of serum biomarkers such as creatine kinase isoenzyme (CK-MB), matrix metalloproteinase-9 (MMP-9), N-terminal pro-brain natriuretic peptide (NT-proBNP) before and after 14 days of treatment were compared between the two groups. Results The left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) of the two groups after 14 days of treatment were lower than those before treatment, and the left ventricular systolic function (LVSF) was higher than that before treatment, with statistically significant differences (all P ＜ 0.05). There were no significant differences in LVEDVI, LVESVI and LVSF between the two groups after 14 days of treatment (P ＞ 0.05). The left ventricular ejection fraction (LVEF), the left ventricular end-systolic dimension (LVESD), peak ejection rate (PER), peak firing rate (PFR) of two groups after 14 days of treatment were significantly higher than those before treatment，and left ventricular end-diastolic diameter (LVEDD) was lower than that before treatment, with statistically significant differences (all P ＜ 0.05). After 14 days of treatment, LVEF and LVESD in group A were higher than those in group B, and LVEDD was lower than that in group B, with statistically significant differences (all P ＜ 0.05). After 14 days of treatment, the levels of CK-MB, MMP-9 and NT-proBNP in the two groups were all lower than those before treatment, and the differences were statistically significant (all P ＜ 0.05). The levels of CK-MB, MMP-9 and NT-proBNP in group A after 14 days of treatment were all lower than those in group B, and the differences were statistically significant (all P ＜ 0.05). Conclusion Both immediate PCI after thrombolysis and primary PCI can improve ventricular remodeling and cardiac function in STEMI patients, but immediate PCI after thrombolysis can significantly improve cardiac function, which is especially worthy of clinical recommendation.

Key words： Immediate percutaneous coronary intervention after thrombolysis Primary percutaneous coronary intervention Acute ST segment elevation myocardial infarction Ventricular remodeling Cardiac function

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	WANG Changliang WANG Rongxin ZHAI Wenliang

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WANG Changliang WANG Rongxin ZHAI Wenliang. Comparative study of ventricular remodeling and cardiac function between immediate PCI after thrombolysis and primary PCI in STEMI patients[J]. 中国医药导报, 2020, 17(17): 62-66,83.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2020/V17/I17/62

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