目的：探讨单中心老年急性ST段抬高型心肌梗死（STEMI）患者应用静脉溶栓治疗后经皮冠状动脉介入治疗（PCI）与直接PCI的临床疗效差别。方法选取2011年10月至2012年1月在沈阳军区总医院心内科住院治疗，发病12h内且无溶栓禁忌证的老年STEMI患者53例，根据临床干预措施分为A组[溶栓加PCI组（23例）]和B组[直接PCI组（30例）]，分析两组患者的临床治疗效果。结果到达导管室冠状动脉造影时梗死相关动脉（IRA）的TIMI 2～3级血流的比率， A组69.6%（16例），高于B组的13.3%（4例），差异具有统计学意义（P＜0.01）。两组患者IRA支架植入术的成功率比较，差异无统计学意义（82.6%vs 90%，P＝0.431）。住院期间两组均无严重出血并发症发生。A组术后左室射血分数值明显高于B组[（56.8±1.12）% vs （51.7±1.00）%，P＝0.001]。结论静脉溶栓联合PCI在老年STEMI患者中具有较高的IRA早期再通率，且并不增加相关出血风险，对于尽早恢复IRA血流以及保护左心收缩功能具有一定的临床意义。%ObjectiveTo compare theoutcomes between direct percutaneous coronary intervention (PCI) and PCI after intravenous thrombolysis intheelderly patientssuffering fromacute ST-segment elevation myocardial infarction (STEMI).MethodsFifty-three elderly patients with STEMI occurring within 12h and without any contraindicationsof thrombolysis hospitalizedin our department during October 2011 and January 2012 were enrolled into this study and retrospectively analyzed. They were divided into2 groups according to the intervention they received,that is, thrombolysis+PCIgroup (group A,n=23) and direct PCI group (group B,n=30). Theclinicaloutcomes were compared between the 2 groups.Results The percentage of ThrombolysisinMyocardialInfarction(TIMI) flowatgrades 2 to3 in infarction related artery (IRA)was69.6% in group A (16 cases), whichwassignificantlyhigher than thatin group B (14.3%,4 cases, P<0.01). There was no significant difference in the successful rate of stent implantation ininfarction related artery (IRA)between the 2groups (82.6%vs 90.0%, P=0.431).No severe hemorrhage complication was observed in both groups during the hospitalization. Left ventricular ejection fraction(LVEF) after intervention was significantly higher in group A thaningroup B[(56.8±1.12)%vs (51.7±1.00)%,P=0.001].Conclusion When compared withdirect PCI,intravenous thrombolysis combinedwithPCI has the advantages ofhigherrate of early recanalization of IRAbut not increasing related hemorrhage riskin the treatment of the elderly STEMI patients, and exertscertain effects on the restoration of blood flow in IRAas early as possibleandontheprotection of contractile function of left ventricule.
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