心肌梗塞后的冠脉内支架对预防再梗塞和改善心功能的探讨

Effects of Intracoronary Stent Placement After Myocardial Infarction on Preventing Reinfartion and Improving Heart Function

１９９５年１１月～１９９８年１０月３２例急性心肌梗塞（ＡＭＩ）患者发病后２～４周行冠脉造影及冠脉内支架术治疗。分为两组，梗塞后心绞痛组２２例，梗塞后心功能不全组１０例。经冠脉造影证实其梗塞相关冠状动脉均处于完全闭塞及次全闭塞状态。梗塞相关血管段２９例为单支，其中左前降支（ＬＡＤ）１５支，右冠状动脉（ＲＣＡ）１０支，左回旋支（ＬＣＸ）４支，３例为双支，分别为ＬＡＤ＋ＲＣＡ，ＬＡＤ＋ＬＣＸ，ＬＣＸ＋ＲＣＡ。术前平均狭窄度（９２．５±５．１）％，平均狭窄长度（１９．５±５．３）ｍｍ。共植入４０枚支架，ＬＡＤ１８枚，ＲＣＡ１４枚，ＬＣＸ８枚，其中６例患者各植入２枚，１例患者植入３枚。手术成功率１００％，１例术后３天后发生亚急性血栓形成。术后造影显示，平均残余狭窄度为０％～１０％，梗塞后心绞痛组临床症状消失，梗塞后心功能不全组的超声心动图提示左房内径（３６．８０±３．４３）ｍｍ，左室内径（５５．１０±３．７３）ｍｍ，左室射血分数０．６１±０．０８，明显优于术前的左房内径（３９．４０±４．１２）ｍｍ，左室内径（５９．６０±５．２５）ｍｍ，左室射血分数０．５２±０．１０。随访１个月～３年无１例死亡，无再梗塞，心功能均在Ⅰ?

Angiography and intracoronary stent were performed in 32 patients in 2～4 week after acute myocardial infarction in our hospital from November 1995 to October 1998.The group comprised of 31 men,1 woman with mean of age (52 7±11 8)years.Twenty Two had postinfarction angina,ten had postinfarction heart failure.The infart related vessel was single in 29 cases,15 in LAD,10 in RCA,4 in LCX,infart related vessel was double in 3 cases,LAD+RCA,LAD+LCX,LCX+RAC,respectively.Mean of lesion length was(19 5±5 3)mm and average diameter stenosis before procedure was 92 5%±5 1%.Forty intracoronary stents were implanted,18 in LAD,14 in RCA,8 in LCX.Six patients received 2 stents,one received 3 stents respectively.The procedure success rate was 100%.After the stents implanting,the diameter stenosis decreased to 0%～10%,postinfarct angina di sappeared. In the postinfart heart failure group,the diameters of left atrial and left ventricular on the UCG were reduced,ejection fraction increased significantly.Our results indicate that intracoronary stents in 2～4 week after myocardial infarction provide a beneficial effect in increasing coronary blood flow,preventing reinfarction,improving left ventricular function and reducing mortality.As compared with angioplasty,coronary stent placement has a higher clinical success rate and reduces the incidence of restenosis.