| Objective: To investigate the optimal time and the effect of the treatment with percutaneous coronary intervention (PCI) for patients with ST segment elevate myocardial infarction(STEMI) by comparing different time in patients with direct PCI.Methods: Within the period of July 2004 through July 2005, 100 cases of initial STEMI in our hospital were enrolled. All of them had not undergone any sort of thrombolytic therapy. 82 cases are male and 18 female. The age range was 36-75 years (55.8 + 11.9). The cases were divided into two groups according to the time that PCI treatment was received. Among them 55 patients had taken coronary angiographies(CAG) and direct PCI within 2-12h (6.9 ± 3.2) after STEMI occurred which named group A, while 45 patients had received CAG and PCI treatment between 12-48h (27.6+9.7) which become the group B. Both groups of patients at the time of study had no significant differences in age, sex, high risk factors, size of infarction, and heart function. Group A and group B proven by CAG that there were no significant differences in infarction relation coronary artery (IRCA) with pathological changes. During the patients stay at the hospital, their creatine kinase-MB(CK-MB) peak value and peak timing were monitored. The time of PCI procedure,ventricular fibrillation and coronary dissection during operation, post operative TIMI III were recorded and divided into postoperative PCI in the 2nd week and the 12th week to do ultraechocardiography (UCG) tests. The number of left ventricular aneurysm(LVA) formed was recorded and left ventricular end-diastolic diameter (LVEDD) was examined along with left ventricular ejection fraction(LVEF) to evaluate the heart function. All the patients of the two groups had been followed up for 6 months. Recurrence of myocardial infarction, blood vessel reconstruction, and the amount of heart failure(HF) and death were all recorded. Results:1. Comparing the results of both groups, it was found that group A decreases CK-MB peak value (90.2 ± 25. 4vsl25.9 ± 28. 3, P<0.05), decreases the amount of time it takes CK-MB to reach its peak (13.5 + 1.2vs28. 3 + 2. 1, P<0. 05).2. Timing of PCI procedure become little short (58. 5 + 11. 2vs60. 8 ±13.4, P>0. 05), rate of occurrence for ventricular fibrillation and coronary dissection during the procedure has no significant difference (3vsl, P>0. 05;0vsl, P>0. 05).3. Compared the results of the two groups' UCG figure that 2 and 12 weeks after PCI LVEDD are (54. 3 ±9. 6vs58. 9 ± 10. 8, P<0.05;53. 7± 10. 2vs57. 8 + 9. 7, P<0.05), LVEFare (59. 1 ± 12. 8%vs50. 2 + 11. 8%, P<0. 05;65. 8±11.5%vs52. 7 + 10. 5%, P<0. 05), In comparison with group A heart function improves. Number of formation of LVA was (0vs3, P>0.05) no significant difference.4. The 6 months follow up of both groups are compared, the total number of death is Ovsl,P>0. 05;recurrence of myocardial infarction is Ivs2, P>0.05;occurrence of heart failure is 0vs3, P>0. 05;occurrence of cerebral apoplexy is Ovsl, P>0.05, there were no epidemiological difference.Conclusion: Under circumstantial terms, within 12 hours after myocardial infarction is the optimal time for the direct PCI treatment, it decreases the size of myocardial infarction, improves heart function and prognosis. Compared to <12h direct PCI, >12h direct PCI obtains the same high rate of establishment for TIMI-ffland the same low rate of cardiovascular events. |
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