冠状动脉内支架植入术治疗急性心肌梗死的临床应用

Role of Intracoronary Stenting in Treatment of Acute Myocardial Infarction

目的：评价冠状动脉内支架治疗急性心肌梗死（ＡＭＩ）的效果。方法：对４８例植入支架的ＡＭＩ连续病例进行回顾性分析。结果：心肌梗死相关血管为：前降支３３例，右冠状动脉８例，回旋支４例，左主干１例以及大隐静脉桥２例。４８例患者共植入５７只支架，其中３４例因球囊扩张后结果不理想，１２例因非闭塞性夹层，２例因闭塞性夹层。支架植入成功率为９３８％，术后残余狭窄降至（２４±７１）％。院内严重并发症３例，其中１例（２１％）死亡，２例（４２％）行急诊冠状动脉旁路移植术。对无院内并发症的４５例患者随访１０．１±７２个月，其中３例失访，出院后２例发生再狭窄和１例有慢性充血性心力衰竭，无其它心脏事件发生。结论：本研究结果表明ＡＭＩ时冠状动脉内植入支架成功率高，并发症少。

Objective:To study the role of intracoronary(IC) stenting in the treatment of the patients with acute myocardial infarction(AMI). Methods:Retrospective case reviews were used.Fourty eight patients were treated by percutaneous transluminal coronary angioplasty(PTCA) and IC stenting during AMI. Results:Eight patients presented in Killip class Ⅲ and Ⅳ,40 patients in Killip class Ⅰ andⅡ.The infarct related vessel(IRV) was left descending artery in 33,right coronary in 8,left circumflex in 4,left main coronary artery in 1 and vein graft in 2 patients.Fifty seven stents were implanted,in 34 patients because of suboptimal result,12 for non occlusive dissection,2 for occlusive dissection.Success rate was achieved was 93.8%.Residual diameter stenosis was(2 4±7.1)%after stent implantation.In hospital complications included 1 death(2.1%),2 patients(4.2%)required emergency coronary artery bypass graft surgery.At follow up of the 45 patients without complications(10.1±7.2 months),3 cases were lost,only 2 patients had restenosis and 1 patient had chronic congestive heart failure,the other patients were cardiac event free. Conclusion:This study demonstrated high success rate of IC stenting during AMI and good short term outcome in a small population.