老年急性心肌梗死溶栓后补救性冠状动脉介入治疗的临床研究

Clinical Efficacy and Safety of Rescue-PCI for Elderly Patients With Acute ST-Segment Elevation Infarction

目的:评价老年急性ST段抬高性心肌梗死病人,在急诊静脉溶栓治疗后,对于梗死相关冠状动脉未能有效开通的病人,进行补救性冠状动脉介入治疗的有效性、安全性及可能出现的特殊问题。方法:按照病人年龄分为≥70岁组(n=52)和<70岁组(n=67)2组,对于≥70岁组急性ST段抬高性心肌梗死病人,在急诊静脉溶栓治疗判定未能有效开通后,则即行冠状动脉造影,若造影显示梗死相关动脉血流为非心肌梗死溶栓治疗临床试验(TIMI)3级灌注、同时病人仍有较明显胸痛,和(或)梗死对应心电图导联ST段仍抬高,并除外急诊冠状动脉介入治疗的禁忌证,则即进行梗死相关冠状动脉的补救性介入再通治疗(包括球囊扩张、支架置入)。同时与<70岁组的ST段抬高性心肌梗死病人进行比较。结果:与<70岁组比较,≥70岁组在进行了静脉溶栓治疗后的急诊冠状动脉造影显示:溶栓有效开通比例低,同时在急性心肌梗死急性期的死亡绝对数较多;但梗死相关冠状动脉血管的介入治疗成功比例两组无差别,同时,在≥70岁组,接受了静脉溶栓治疗后,再行介入治疗的严重出血并发症(包括颅内出血、消化道大出血等)也未见显著增加。结论:≥70岁组急性心肌梗死病人,静脉溶栓有效开通比例较低,进行补救性冠状动脉介入成功比例与<70岁组相同,严密监测出、凝血参数,出现严重出血并发症低。

Objective:To evaluate the efficacy and the safety of rescue-PCI after failure of intravenous thrombolysis in elderly patients with ST-segment elevation acute myocardial infarction(STEMI). Methods: One hundred and nineteen consecutive patients(52≥70 years,67<70 years) with ST-segment elevation acute myocardial infarction underwent rescue-PCI.The immediate results and in-hospital outcomes were compared between two groups. Results: Procedural success rate (96.6% vs 98.7%, p>0.05), emergency coronary artery bypass graft(CABG) and mortality rate had no significantly statistic differences between the two groups. But the patients ≥70 years suffered a much higher absolute mortality (4 vs 0). There was no difference in severe hemorrhage between the two groups. Conclusion: Rescue-PCI for the elderly acute myocardial infarction patients following intravenous thrombolysis failure showed satisfactory effectiveness and reliable outcomes and little severe fatal hemorrhage.