| Objective: To evaluate the effect of direct conorary intervention for improving the left ventricular function during acute myocardial infarction(AMI). To elucidate the meaning of restricting infarction zone and protecting the function of left ventricular by intervention therapy for the AMI.Materials and methods: The admission patients who were selected from 1999 to 2003 for AMI, the patients were devided into two groups , the age, gender, nationality, state of an illness of patients between two groups were balanced. One group was non-intervention, 57 patients were contained, males 48, female 9, average age was 58. 76+10. 52, from 34 to 80, ; Han 42, minority 16; anterior AMI 33, posterior AMI 24, average chest pain time was 6. 21?. 23 hours; thrombolytic therapy was carried through in 73.68% of patients(42/57), anticoagulation therapy was carried through in 26.32% patients. Another was direct intervention group ,50 cases were contained , among them 40 males, 1.0 females; anterior AMI 21, posterior AMI 29; Han 42, minority 8; average age was 59. 44 ?0.54; average admission chest pain time was 6.44 + 4.92 hours. Because the effect to cardiac function of anterior and posterior was different, for the sake of analysis, non-intervention and intervention group were devided into 2 subgroups respectively, non-intervention was devided into ?non-intervention anterior AMI group, (2).non-intervention posterior AMI group; the intervention group was devided into ﹊ntervention anterior AMI group, ﹊ntervention posterior AMI group. To compare the non-intervention anterior AMI group and ntervention anterior AMI group; non-interventionposterior AMI group and intervention posterior AMI group. Routine thrombolytic therapy was carried through when non-intervention patients who were fit for thrombolytic therapy, 500OOOu urokinase was injected intravenous immediately, then lOOOOOOu urokinase was dripped intravenous within 30 min. The change of ECG and myocardial enzyme before thrombolytic therapy and 1, 3, 5, 7, 9, 12,24 hours were observed, to confirm the peak value of CK-MB, so that we could estimate whether Infraction relative artery(IRA) was reopened. To the patients who weren' t fit for thrombolytic therapy, appropriate anticoagulation were carried through. The ECG and echocardiography were obtained after 1 week.PTCA and stenting technique were applied to treat culprit artery in intervention group, IRA was reopened by mechanical method. The change of ECG and myocardial enzyme before PTCA and stenting and 1,3,5,7,9,12,24 hours were observed, to confirm the peak value of CK-MB. Aspirin and clopidogrel or ticlopidine were used routinely, Anticoagulation drug such as low molecular weight heparin was injected subcutaneous. The coronary artery forward flow TIMI grade above II was confirmed reopened, the ECG and echocardiography were obtained after 1 week.Results: After thrombolytic therapy, the IRA of 31 patient of non-intervention group reopened, the others still remained occlusion, reopened rate was 54.39%, ventricular aneurism formed in 2 anterior AMI patients. 3 patients in non-intervention posterior AMI group were dead, mortality was 5.2%. There were 14 single artery lesion, 22 twi-artery lesions and 13 tri-artery lesions in intervention AMI group. According to angiography and change of myocardial enzyme, the IRA of 49 of intervention AMI group reopened, the reopened rate was 98%, ventricular aneurism formed in 1 anterior AMI patients. 2 patients of intervention were dead , among them , one patient died of no-flow phenomenon after stenting, another died of severe digestive system hemorrhage, the cardiac mortality was 2%. The cardiac mortality of intervention group was lower than non-intervention group (P=0. 0018) . 1 week after admission, the number of Q wave,the number of ST elevation, the peak value time of CK-MB were less in interven! ion group patients. The LVEF and wall motion of intervention group were higher than non-intervention group, as fpr 6-minute walk test, exercise tolerance an...
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