| Objective: This paper was to investigate the effect of direct percutaneous coronary intervention (PCI) and thrombolysis in AMI (acute myocardial infarction, AMI) patients with heart dysfunctionMethods: 166 patients with first AMI in our hospital from January 2001 to August 2003 were enrolled. All the patients were the first onset AMI and accorded with the criterion of WHO. The patients with clinical evidence of cardiac shock, medium or serious insufficiency of renal function, serious valvular heart diease, dilated cardiomyopathy, hypertrophic cardiomyopathy,contra-indications of anticoagulation therapy, hemorrhage diease, history of any type of cerebrovascular event in past 6 months and history of heart dysfunction were excluded. All patients were devided into two groups accoding to Killip grade: KillipII-III group,79cases, male 66 cases, female 13 cases , average age 62.4±12.9 years; Of the 79 cases, 43 cases for direct PCI treatment, 36cases accept thrombolitic treatment. KillipI group, 87 cases , male 71 cases, female 16 cases , average age 56.8±11.6years ; Of the 87 cases, 39 cases for direct PCI treatment ,48 cases accept thrombolitic treatment. The patients of direct PCI underwent emergency coronary angiography(CAG) and emergency PCI treatment immediately. Quantitative coronary angiography(QCA) was used to analyse the condition of coronary artery. PCI was considered successfully when thrombolysis in myocardiual infarction (TIMI)grade III flow with residual stenosis of ≤10% was obtained and there were no significant complications . The success of thrombolysis were investigated according to the criteria which was formulated by editorial board of chinese Journal of cardiology, all of them were confirmed by CAG. All the patients underwent equilibrium radionuclide angiocardiography(ERNA)at 1-2 weeks and 24 weeks after AMI. Left ventricular ejection fraction(LVEF), Left ventricular peak ejection rate(LPER), Left ventricular time to peak ejection rate(LTPER), Left ventricular peak filling rate(LPFR), Left ventricular time to peak filling rate(LTPER) were measured to evaluate left ventricular function. The major adverse cardiac events (MACE) were also recorded 1-2 weeks and 24 weeks after AMI. All of these data underwent statistics test by SAS 6.12 software , which has the significant difference in statistics if p<0.05. Results: 1. There had no significant difference between KillpII-III group and KillipI group about the incidence of diabetes , the history of hypertension , the level of the cholesterol, medince treatment and the time from onset to treatment. The average age of KillipII-III group were much higher than that in KillipI group, p<0.05.There were significant difference in the incidence of anterior AMI, the incidence of ventricular tachycardia and ventricular fibrillation( VT/VF) and the creatine kinase(CK) peaks between KillpII-III group and KillipI group, p<0.05. 2.There had no significant difference between direct PCI and thrombolysis group about the ages, sex, smoking , high risk factors, the family history, the incidence of anterior AMI , general medcine trentment , the incidence of VT/VF and CK peaks, p<0.05. In KillipII-III group, there had significant difference between direct PCI subgroup and thrombolysis subgroup about re-patency rate, 97.7% vs 75.0%, p<0.05 there were 4 patients performed rescue PCI treatment. In Killip I group , there also had significant difference between direct PCI subgroup and thrombolysis subgroup about re-patency rate, 100% vs 77.1%, there were 5 patients performed rescue PCI treatment, p<0.01. 3. In KillipII-III group , the systoylic function and the diastolic function of direct PCI subgroup at 24 weeks were better than that at 1-2weeks, compared with thrombolysis subgroup, the cardiac performance of direct PCI subgroup were better, after AMI 1-2weeks the systoylic function (LVEF, PER,TPER)of direct PCI and hrombolysis subgroupp were 44.02±5.64% vs 39.33±5.85%,2.81±0.58 EDV/S vs 2.47±0.35 EDV/S,168.7±22.3 ms vs 199.6...
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