直接经皮冠状动脉腔内成形术治疗急性前壁心肌梗死合并泵衰竭的体会

Primary percutaneous transluminal coronary angioplasty for acute anterior wall myocardial infarction complicated with pump failure

目的 探讨直接经皮冠状动脉腔内成形术 (PTCA)治疗急性前壁心肌梗死 (AMI)合并泵衰竭的近期及远期疗效。方法 对急性前壁心肌梗死合并泵衰竭发病至入院时间 <12小时的 2 8例患者行直接PTCA并置入冠状动脉内支架。结果 2 8例梗塞相关冠状动脉 (IRCA)均为左前降支(LAD)近端或起始部 ,TIMI血流 0～Ⅰ级 ,单支病变 15例、双支病变 9例、三支病变 4例 ,PTCA即刻成功率 10 0 % ,IRA血流均达TIMIⅢ级灌注。 1例未置入支架者手术后第二天再发胸痛 ,并发急性肺水肿死亡。 2 7例存活病例随访 1～ 36个月无死亡 ,LVEF 5 9 8± 6 5 %。结论 对前壁心肌梗死合并泵衰竭 ,包括对升压药有反应的KillipⅣ级患者行直接PTCA安全、可靠、可明显改善心功能 ,降低病死率提高近期及远期疗效。

Objective To evaluate the short term and long term outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) for acute anterior wall myocardial infarction (AMI) complicated with pump failure Methods 28 patients admitted within 12 hours after the onset of AMI and complicated with heart failure underwent primary PTCA and stent implantation The short term and long term therapeutic effects were observed Results The infarct related coronary arteries (IRCA) of the 28 patients were all LADs with occlusions at the proximal or beginning segment and TIMI flow was 0 Ⅰ Single vessel disease was showed in 15 patients,double vessel disease in 9 and triple vessel disease in 4 The immediate procedural success rate was 100% with TIMI flow Ⅲ in all IRCAs One patient without stent implantation had a recurrent chest pain 2 days after procedure and died of acute pulmonary edema During 1～36 month follow up of the 27 survivors, no death occured and the average LVEF was showed 59 8±6 5% by echocardiography Conclusion Primary PTCA for AMI complicated with pump failure was safe and effective to improve the short term and long term outcomes