急性心肌梗死桥血管病变急诊介入治疗的临床研究——年龄组对比分析

Clinical efficacy and safety of emergent percutaneous coronary intervention for vein-grafts in patients with acute myocardial infarction: comparison between age groups

目的 评价包括 ST段抬高性和非抬高性急性心肌梗死 (AMI)患者在急诊冠状动脉 (冠脉 )造影明确其梗塞相关血管为静脉搭桥血管 (SVBG)后 ,进行急诊直接经皮血管成型术 (PCI)的临床有效性及安全性 ;比较≥ 70岁与 <70岁两组患者 SVBG病变再通的临床效果和不良事件。方法 分析 2 0 0 3年 1月—2 0 0 4年 11月在解放军总医院和德国海德堡大学附属海德堡医院行急诊介入治疗的连续 AMI患者 30 9例 ,其梗塞相关血管为 SVBG患者。全部患者行急诊冠脉造影 ,根据造影显示梗塞相关 SVBG血流为心肌梗死溶栓治疗临床试验 (TIMI) 级以下 ,或同时伴有较明显胸痛 ,梗塞对应心电图导联 ST段仍抬高或压低 ,并均在确认无介入治疗禁忌证后行急诊 PCI治疗 (包括球囊成型术或支架术 )。比较两组患者即刻 SVBG再通效果、血管有效再通成功率、住院期间病死率及短期临床效果。结果 急诊 PCI治疗 SVBG罪犯血管共 30 9例支 ,≥ 70岁组 2 13例 ,<70岁组 96例。两组患者中应用各种血管远端保护器者 4 7例 ,其比例两组间差异无显著性。两组患者行球囊扩张术和支架植入术的技术成功率、急性再闭塞率差异均无显著性。≥ 70岁组 SVBG直接 PCI后发生慢血流或无血流现象明显增多 ,住院期间绝对死亡数多 (2 0 /2 4例 ) ,均较 <70岁组明显?

Objective To evaluate the efficacy and the safety of emergent primary percutaneous coronary intervention (PCI) in the saphenous vein bypass graft (SVBG) of acute myocardial infarction (AMI) , and compare the results between aged patients with nonaged patients. Methods Three hundred and nine consecutive AMI patients with culprit SVBG vessels, were analysed, including aged patients 213 cases ( ≥70 years old), nonaged patients 96 cases(<70 years old), underwent the emergent primary PCI after confirmed below TIMIⅢ perfusion(TIMI 0-TIMIⅡ) in coronary angiographies. The immediate results and inhospital outcomes were compared between two groups. Results Procedural successful rate, reocclusion rate, and emergency reCABG had no significant differences between two groups. The rate of slowflow/noreflow and inhospital mortality rate were significantly higher in elderly group (19 7% vs 10 4%, 9 4% vs 4 2%, both P <0 05), with no difference in the rate of the using of distal protection devices between two groups. The comparison of the rate of direct stenting in slowflow/noreflow subgroup with normalflow subgroup , had not showed statistic difference (73 5% vs 67 3%, P >0 05). There was no statistic difference of heavy hemorrhage between two different age groups. Conclusion The primary PCI for the elderly AMI patients with infarctionrelated SVBG vessels, has higher risks in slowflow/noreflow and the mortality, even with using the distal protection devises and direct stents implantation .