青年人及老年人急性心肌梗死直接经皮冠状动脉腔内成形术的特征

Characteristics of primary percutaneous transluminal coronary angioplasty in the young and the elderly with acute myocardial infarction

目的 探讨 40岁以下青年人及 6 0岁以上老年人急性心肌梗死 (AMI)直接PTCA特点。方法 对 2 7例 40岁以下青年及 34例 6 0岁以上老年AMI患者直接PTCA进行分析。结果 青年组93%为单支病变 ,均无钙化 ,钢丝一次性通过顺利为 10 0 % ,支架置入率低 44 4% ,手术过程短 ,平均(35 2± 10 3)min ,术后恢复顺利。老年组 42 %病例为双支以上病变 ,且钙化病变多见 ,支架置入率高 ,手术过程较青年组长 ,平均 (48 3± 8 4)min。两组PTCA成功率均 10 0 % ,老年组有 2例女性三支病变 ,术后分别于 1天、2天死于泵衰竭。结论 AMI直接PTCA成功率高 ,明显降低病死率 ,对老年人多支复杂病变行直接PTCA应慎重。

Objective To investigate the characteristics of primary percutaneous transluminal coronary angioplasty (PTCA) in the young and the elderly with acute myocardial infarction (AMI) Methods Twenty seven young patients under 40 years old and 34 elderly ones over 60 years old who suffered from AMI and underwent primary PTCA were analyzed Results In the young group, 93% of the patients had single vessel disease without calcification which was readily crossed with the guidewire, there were a lower stent implantation rate (44 4%) and a shorter procedural time (35 2±10 3)min; In the elderly group, 42% of the patients had multi vessel disease and the calcified lesions were commonly seen, there were a higher stent implantation rate (94 1%) and a longer procedural time (48 3±8 4)min The procedural success rate was 100% both in the two groups, but two elderly female patients died of heart failure 1～2 days after procedure Conclusion There was a high success rate in primary PTCA for AMI which can significantly reduce the mortality and shorten the hospitalization time, much more attention should be paid to the elderly with complex multi vessel disease during the procedure