急性心肌梗死急诊介入治疗的即刻和随访结果

Emergency percutaneous coronary Intervention in 168 patients with acute myocardial infarction:immediate and follow-up results

目的 分析本院急诊行经皮冠状动脉介入治疗 (PCI)的 16 8例急性心肌梗死 (AMI)患者的即刻和随访结果。 方法 1997年 3月～ 2 0 0 4年 4月作者对 16 8例AMI患者经股动脉行急诊PCI ,其中 14 0例ST段抬高性心肌梗死 (STEMI)患者行直接PCI治疗 ,补救PCI治疗 8例STEMI ,急诊PCI治疗 2 0例非ST段抬高性心肌梗死 (NSTEMI)。 结果 直接PCI手术操作成功率为 97%,术中无复流发生率 8.6 %。 1例应用了主动脉气囊反搏术 ,5例应用了血栓吸引装置。3例发生支架内急性 /亚急性或后期支架内血栓形成 ,住院死亡 7/ 14 0例 (5 .0 %) ,6个月死亡 8/ 14 0例 (死亡率 5 .7%)。补救性PCI术后 7例患者的严重心肌缺血和 (或 )急性肺水肿的症状得到明显改善 ,1例合并心源性休克的多支血管病变患者术后2小时死亡。NSTEMI的介入操作成功率 10 0 %,所有患者的临床缺血症状迅速改善。 结论 直接PCI扩大了治疗STEMI的适应证 ,可迅速使梗死相关动脉开通并恢复正常血流 ,高危患者术后存活率高 ,住院时间缩短。补救性PCI是静脉溶栓治疗失败后的一种有效补救措施 ,但同样具有较高风险。急诊PCI对于改善NSTEMI患者的缺血症状非常有效 ,再缺血。

Objective To analyze immediate and follow-up results of 168 patients with acute myocardial infarction(AMI)which underwent emergency percutaneous coronary intervention(PCI). Methods One hundred and sixty-eight patients with AMI underwent emergency PCI by transfemoral artery approch. Among them,primary PCI was performed in 140 patients with STEMI, rescue PCI was rerformed in 8 patients with STEMI, and emergency PCI was performed in 20 patients with NSTEMI. Results A successful primary PCI procedure was achieved in 97% STEMI patients with incidence of no-reflow in 8.6%.Of 140 patients, 1 case underwent PCI procedure with the help of intra-aorticballoon counterpulsalation, and the distal protecion device was used in 5 patients.Acute/subacute or late instent thrombosis occurred in 3patients. In-hospital mortality was 5.0 %(7/140),and 6 month-mortality was 5.7% (8/140).All 8 patients with STEMI which underwent a successful rescue PCI, and the severe myocardial ischemia and/or acute pulmonary congestion were relieved in 7 patients, but one patient with multi-vessel disease died of cardiogenic shock at two hours after the procedure. The successful rate of emergency PCI procedure in patients with NSTEMI was achieved in 100%.The ischeamic symptoms of NSTEMI patients were relieved. Conclusion Primary PCI expanded the indication for treatment of STEMI patients with establishment of patent infarct related artery and nomal blood flow, increased the survival of high-risk patients, and shortened the hospitalization. Rescue PCI is an effective measure for STEMI patients failing to intravenous thrombolysis but it has high risk. Emergency PCI is very effective in relief of ischemic sympotoms of NSTEMI patients with lower incidence of recurrence of ischemia, reinfarction and reocclusion.