急诊冠状动脉造影在急性胸痛持续发作中的应用价值

The practical value of emergency coronary angiography in patients with acute cardiac attack of persistent chest pain

目的：评价急诊冠状动脉造影用于拟诊急性缺血性心脏病胸痛病人的价值。方法：对持续胸痛０．５ ～１２ｈ，心电图拟诊急性缺血性心脏病的病人，急诊行冠状动脉造影术，对确诊为急性心肌梗死而梗死相关动脉ＴＩＭＩ血流≤Ⅱ级者行直接经皮腔内冠状动脉成形术（ｐｅｒｃｕｔａｎｅｏｕｓｔｒａｎｓｌｕｍｉｎａｌｃｏｒｏｎａｒｙａｎｇｉｏｐｌａｓｔｙ，ＰＴＣＡ）。结果：５９ 例疑为急性缺血性心脏病发作的病人中，５ 例（５／５９） 被除外冠心病，５４ 例（５４／５９） 确诊为急性心肌梗死，其中单支血管病变２８ 例，双支病变１７ 例，三支病变４ 例，左主干合并三支病变１ 例，冠状动脉造影正常４ 例。梗死血管前降支病变２４ 例，右冠状动脉病变２３ 例，回旋支病变３ 例。对其中４３ 例ＴＩＭＩ≤Ⅱ级心肌梗死病人的梗死相关动脉进行直接ＰＴＣＡ 术，手术成功率１００ ％ ，ＴＩＭＩ血流Ⅲ级４０ 例，Ⅱ级３ 例，３３（３３／４３） 例病人置入冠状动脉内支架。术中无１例出现严重并发症。结论：急诊冠状动脉造影术对急性胸痛持续发作病人是安全和可行的，它可准确判断冠状动脉病变的有无，同时对冠状动脉堵塞引起急性心肌梗死病人可同时进行直接ＰＴＣＡ 术，从而改善预后。

Objective: To evaluate the value of emergency coronary artery angiography in patients with persistent chest pain during suspected acute ischemic heart attack. Methods:Emergency coronary artery angiography was performed in patients with suspected acute coronary heart disease from 0.5 to 12 hours from onset of chest pain. According to the results of coronary angiography,direct angioplasty was performed in patients with acute myocardial infarction (AMI)with infarct related artery TIMI Ⅱ flow or less. Results:Of the 59 patients with persistent chest pain of suspected acute ischemic heart attack, in 5(5/59) patients ischemic heart disease was ruled out,and the remainders were diagnosed as AMI. Of the 54 patients with AMI, coronary angiography showed normal coronary artery in 4 patients,single vessel disease in 28, double vessel disease in 17, triple vessel disease in 4,left main accompanying with triple vessel disease in 1.Infarct related arteries were left anterior descending artery in 24, right coronary artery in 23, left circumflex in 3.Direct angioplasty was performed in 43 patients with AMI. Procedural successful rate was 100%, and TIMI Ⅲ flow was achieved in 40(40/43). Coronary stents were implanted in 33 (33/43). No one died during all of the procedures. Conclusion:Emergency coronary angiography was a safe and reliable procedure in patients with persistent chest pain suspected acute ischemic heart disease. It is helpful to diagnose whether there is coronary artery disease, and to identify infarct related artery and TIMI flow of AMI. Direct angioplasty and stenting could be done simultaneously to improve patient’s prognosis.