| Objective To compare the clinical outcomes of primary percutaneous coronary intervention (p-PCI) with thrombolytic therapy in acute myocardial infarction(AMI) during hospital and follow-up period, and to analyze the related risk factors affecting the clinical efficacy.Methods The cohort study was used. From September of 1999 to June of 2002, a total of 192 patients with AMI were enrolled to receive one of the two treatment, 76 patients were performed p-PCI, and 116 patients to undergo thrombolytic therapy. The clinical efficacy of the two group was compared.Results l.The two treatment group were closely matched in terms of base-line characteristics of the patients (P>0.05). 2. The patency rate of related-infarct artery (IRA) in patients with p-PCI group was significantly higher than that of patients with thrombolysis group(90.8% vs 56.9%, P<0.01). The incidence of reperfusion arrhythmia in p-PCI group was also significantly higher than that in thrombolysis group(63.2% vs 37.9%, P<0.01). 3. The rate of Killip class II and III in hospital period were no significant difference in the two groups, but compared with thrombolysis group, the rate of Killip class I in p-PCI group was significantly higher (68.4% vs 50.9%, P<0.05), and the rate of Killip classIV in p-PCI group was significantly lower (0% vs 6.0%, P<0.05). In follow-up period of 3-month, 6-month, 1-year and 2-year, the rate of NYHA class I ,II and III in p-PCI group were significantly higher than that of the same period in thrombolysis group(P>0.05). Except the rate of NYHA class IV in p-PCI group in 3-month was significantly lower than that in thrombolysis group(0% vs 6.3%, P<0.05), the rate in others of 6-month, 1-year and 2- year were no significant difference in the two groups(P>0.05). 4. In hospital and follow-up period of 3-month, 6-month, lyear and 2 year, the cumulative incidences of heart failure in p-PCI group were significantly lower than that of the same period in thrombolysis group (9.3% vs 30.6%, 38.7% and 40.5 %, P<0.01). 5. In hospital and follow-up period of 3-month, 6-month, 1 -year and 2-year, compared with the same period in thrombolysis group, the left ejection fractions (LVEF) in p-PCI group weresignificantly higher(58.39% vs 52.83%, 59.00% vs 52.20%, 60.40% vs 51.90%, 62.47% vs 53.45% and 61.11% vs 53.11%, PO.01); the incidences of left ventricular regional wall motion were significantly lower(58.0% vs 78.3%, 68.1% vs 86.0%, 55.9% vs 82.1%,47.8% vs 76.3% and 53.3% vs 76.5%, P<0.05 0.01); and the left ventricular end-diastolic diameters(LVDD) were also significantly lower(50.64vs 52.95, 50.04 vs 53.32, 49.88 vs 53.37, 49.70 vs 53.45 and 49.58 vs 52.97mm, P<0.05 0.01). 6. In hospital and follow-up period of 3-month, 6-month, 1-year and 2-year, the cumulative incidences of recurrent angina in thrombolysis group were significantly higher than that of the same period in p-PCI group (48.6% vs 16.0%, 70.3% vs 21.3%, 70.3 % vs 24.0% and 71.2 % vs 25.3%, P<0.01), but there were no significant difference in the two groups in other incidences of recurrent heart events such as cumulative reinfarction, re-PCI, CABG and readmission (P>0.05). 7. In hospital and follow-up period of 3-month, 6-month, 1-year and 2-year, the cumulative mortalities in thrombolysis group were significantly higher than that of the same period in p-PCI group (14.4% vs 4.0%, 17.1%, 18.9%,22.5%, 25.2 % vs 4.0%, P<0.05 0.01).Compared with p-PCI group, the 2-year cumulative mortality in patients with age over 60 years and with anterior myocardial infarction in thrombolysis group were also significantly higher(34.2% vs 7.9% and 33.3% vs 5.3%, P<0.01). 8. In hospital and follow-up period of 3-month, 6-month, 1-year and 2-year, the cumulative survival rates in p-PCI group were significantly higher than that of the same period in thrombolysis group (97.3% vs 90.1%, 96% vs 82.9%, 81.1%, 77.5% and 74.8% P<0.05 0.01), the Kaplan-Meier survival analysis showed that compared with thrombolysis group, the 2-year survival rate of patients with p-PCI group was not only sig...
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