药物洗脱支架应用于ST段抬高型心肌梗死急诊冠状动脉介入治疗临床分析

Clinical analysis of drug-eluting stents in the emergency percutaneous coronary intervention with ST-segment elevation myocardial Infarction

目的观察药物洗脱支架应用于急诊冠状动脉介入治疗ST段抬高性型心肌梗死的疗效和安全性。方法选择我院急诊住院的22例ST段抬高性急性心肌梗死患者，男18例，女4例，年龄40—79岁，平均年龄为（60．3±11．7）岁。发病至手术时间为1．5～11h，平均（4．4±2．78）h，在发病12h内急诊行经皮冠状动脉介入（percutaneous coronary interverjtion）治疗，将22例患者植入Firebird和ENDEAVOR支架，并对临床资料，住院期间的心脏事件发生率进行分析，同时对比观察分析两组不同的药物洗脱支架的病变特征，术后住院期间和随访期间再梗死，、死亡等心血管不良事件。结果全部患者造影证实PCI即刻恢复TIM13级血流达到95．7％，4．3％恢复TIM12级血流，改善了ST段抬高型心肌梗死患者的房室传导功能，并发症发生率低。其中两组药物洗脱支架患者住院期间心脏不良事件发生率无显著性差异。住院期间无急性或亚急性血栓形成，在长达两年的随访中，22位病人并未出现心源性死亡，无再发新梗死。结论药物洗脱支架（Firebird支架和ENDEAVOR支架）在急诊冠状动脉介入治疗ST段抬高型心肌梗死中是安全有效的。

Aim To observe the security and therapeutic effect of drug-eluting stent in the emergency percutaneous coronary intervention with ST-segment elevation myocardial infarction. Methods Twenty-two patients （ 18 men,4 women, aged from 40 - 79, mean age 60.3 ± 11.7 years） with ST-segment elevation myocardial infarction were treated by emergency PCI with Firebird stents and ENDEAVOR stents within 12hours. Thedoortoballtimewasfroml. 5 hourstol 1 hours, themeantime （ 4.4 ±2.78 ） hours. Weobservedandanalysed the clinic data and cardiac events and compared the clinic feature and cardiac events such as cardiac death and new myocardial infarction between two kinds of drug-eluting stents in duration of hospital stay and follow-up period. Results The result of angiography showed that after PCI the immediate recovery rate of TIMI grate 3 flow reached 95.7% and the immediate recovery rate of TIMI gratde 2 flow reached 4.3%. The emergency PCI improved the function of atrioventricular conduction and the incident rate of complication was low. No significant difference was observed in-hospital cardiac events between two kinds of drug-eluting stent. There was no acute or subaciate thrombsis in duration of hospital stay and in the next two years follow-up period. There was no cardiac death and new myocardial infarction. Conclusion Implantation of drug-eluting stent in the emergency percutaneous coronary intervention with ST-segment elevation myocardial infarction is safe and effective.