| Objective: In this randomized study ,We performed the comparison of facilitated PCI and primary PCI respectively in the acute myocardial infarction patients by the coronary angiography (CAG),left ventriculography (LVG),99mTc-methodxy isobutyl isomitrile (99mTc-MIBI) myocardial perfusion image (MPI) and equilibrium radionuclide angiography ( ERNA) on the effects and complications of the two methods.Discussed the feasibility and safety of the facilitated PCI ,then provided a more rational strategy of perfusion treatment for AMI patients.Methods: From January 2002 to December 2003,94 patients (86 male and 8 female, average age was 52.90±10.35 years old) who had the first myocardial infarction within 12 hours were enrolled in our study.All patients had persistent angina for more than 30 minutes and the cardiac enzyme peak beyond two folds of normal range and troponin positive and /or ECG showed ST segment elevation beyond 2 leads or new left bandle branch block. Patients with the history of old myocardial infarction, the history of CABG, severe valvular heart disease, dilated and hypertropic cardiomyopathy, medium and serious insufficiency of renal function, contra-indications of anticoagulation therapy were all excluded. These 94 cases were randomizedly divided into group A (facilitated PCI group, n=36, 33 males,3 females, mean years was 53.86±11.14) and group B (primary PCI group, n=58, 53 males, 5 females, mean years was 51.95±9.56).In the group A, the patients first recieved thrombolytic treatment with rt-PA 50 mg, After the thrombolytic treatment, The patients were tranfered to the catherlab at once, received the CAG,If the IRA was also occluded or the left stenosis was beyond 70%,Did the PCI.In the group B, the patients only received CAG and PCI. Before the CAG,We used enough clopidogrel and heparin, and ACT was controlled about 250 seconds. During the PCI, We only treated the IRA. In each group ,we collected clinical information detailed including: year, sex, risk factors,angina before the AMI, location of the AMI, distribution of lesions, heart function, the myocardial enzyme, the mean interval from onset to PCI and the complications and mortality in-hospital, We used QCA ( the narrow more than 70 percent was positive) and TMP to analysis the lesion and reperfusion of the IRA and myocardial. We recorded the LVEDP and left ventricular wall movement scores through LVG. All patients received ERNA and MIBI MPI in 1 week from the PCI to evaluate the heart function and myocardial infarction area. Then compared the left ventricular wall movement scores , the ratio of acute ventricular aneurysm , infarction areas in 99mTc-MIBI MPI, and left ventricular function parameters. We used SAS 6.12 statistics software to analysis all of the data.The variables were presented as the means and the SD.Differences between group means were assessed with the t test.The x2 analysis or the fisher exact test was used to test differences between proportions. Statistical significance was indicated by P value <0.05.Results: There was no significant differences about age, sex, risk factors, IP, the location of the AMI, heart function, and the mean interval from onset to the PCI between A and B group.In the group A,The patients received reperfusion treatment about 3 hours earlier than that in group B,and patients with TIMI 3 grade flow were more than that in group B before(47.22% vs 10.34%, p<0.01) and after PCI(100% vs 91.38%, p<0.05). no-reflow was fewer in group A(0% vs 8.62%, p<0.05).And the successful rate of PCI was higher in the group A(100% vs 8.62%, p<0.05).the myocardial perfusion was better in the group A,the patients with TMP beyond 2 grade were more than that in group B(66.66% vs 51.32%, p<0.05).The myocardial infarction area was smaller in the group A(12.13±3.61% vs 20.13±5.92%, p<0.01). the peak of creatine kinase and creatine kinase MB were much lower in the group A than that in group B(2235.06±942.64 vs 2726.10±857.34,200.50±91.40 vs 294.78±169.88, p<0.01, respectively).The ventricula... |
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