| Background and objectionST-segment Elevation Acute Myocardial Infarction (STEMI) needs urgent intensive treatment. The early reperfusion therapy being the core treastment in clinical practice. More than 50% of patients due to various reasons didn't accept early reperfusion therapy in China, and more than 40% of patients did PCI therapy in subacute period in western countries, part patients who accept early revascu-larization treatment, but didn't get a real effective reperfusion therapy. In the acute stage the patients who cannot accept the early reperfusion therapy, should accept the elective revascularization treatment, or accept simple internal medicine treatment, the conclusion is controversial. In 2006, at the AHA states meeting the OAT trail was reported, the result indicated that in contrast to the later Revascularizatiopn with simple drug therapy, there was no significant difference in the death, re-myocardial infarction, heart failure in two groups, but in the delay PCI group the events of treatment has a trend to increase. The ACC/AHA/SCAI made the percutaneous coronary intervention (PCI) treatment guidelines update in the 2007, it emphasised that the patients with one or two artery occlusion, such as no symptoms, no serious hemodynamic ischemic evidence, did not suggest to accept the delay PCI therapy. In our country most scholars think that the delay PCI cannot reduce the myocardial cells destruction, but can improve "infarction "or "hibernation" of myocardial cells, increase the blood supply of local region of myocardial infarction in the acute phase, promote healing, inhibit the extension and left heart infarction, improve patients' long-term reconstruction, increase the collateral circulation around infarction, increase stability of the electrical activity of myocardial cells, and reduce the malignant arrhythmia, improve the long-term prognosis of STEMI. The research aim to the dispute about the treatment of delay PCI and simple drug therapy, to evaluate the effect of delay PCI therapy of the clinical work in real situation.Methods1,564 STEMI cases was selected in three hospitals of two cities of henan province from January 2004- July 2006 for 2.5 years.291 patients did not receive the early PCI, part of patients received thrombolytic therapy in myocardial infarction. In 2-15 days the PCI therapy was accepted as the delay PCI group, and the STEMI patients chosen in the acute phase did not accept any PCI therapy as control group.2,During the 4-6 years following-up, we investigate the mortality of the patients, heart failure, re-infarction, the events of the joint MACE index, angina recurrence and repeated myocardial ischemic events, PCI or CABG revascularization events, stroke events, and so on.3,SPSS18.0 application software statistics processing.Results1,The delay PCI therapy is a lower mortality of the patients than the pure drugs therapy. (9.62% vs 16.84%, P=0.003);2,The delay PCI therapy can improve the left cardiac function more significant in the long -term treatment group than the pure drugs therapy. (12.71% vs21.99%, P =0.001); 3,The incidence of recurrence myocardial infarction in two groups have not statistical difference. (9.62% vs 11.72%, P=0.35);4,The major adverse cardial events (MACE) have significant statistical difference in two groups. (31.96% vs 49.45%, P<0.013)5,Repeated hemodynamic ischemic evidence in two groups of patients have significant statistical difference in two groups. (10.99% vs 37.73%, P<0.001)6,Later revascularization (PCI or CABG) ratio is significant statistical difference; (4.12% vs 20.51%, P<0.001), the drug treatment group revascularization rate is higher than the delay PCI therapy.ConclusionThe experimental result shows that:for most patients the delay PCI therapy is better than pure medication in the real clinical satuation, the results conflict the result of OAT trial. |
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