常规急诊及尿激酶溶栓失败后补救性冠脉介入治疗急性心肌梗死的疗效

Therapeutic effect of routine emergency and remedial percutaneous coronary intervention on patients with acute ST-segment elevation myocardial infarction

目的:评价急性ST段抬高型心肌梗死(STEMI)常规急诊及尿激酶溶栓失败后行补救性经皮冠状动脉介入治疗(PCI)的近期疗效及安全性。方法:回顾分析2006年6月～2009年12月在我院因急性STEMI而行急诊PCI术的134例患者的基本资料(包括溶栓失败行急诊补救性PCI患者),及其术后30d内的主要终点事件(包括全因死亡、再梗死)以及严重出血性并发症的发生情况。结果:急诊PCI术患者共计134例,其中17例(12.68%)因外院尿激酶溶栓失败转入我院行补救性PCI。134例中30d内共7例(5.22%)发生主要终点事件,死亡6例(4.48%)。多因素Logistic分析显示冠状动脉TIMI血流≤1级和主要终点事件明显相关(OR=60.98,P<0.05)。3例(2.24%)发生严重出血性并发症。单因素Logistic分析显示补救性PCI术与严重出血并发病无显著相关(P>0.05)。结论:急性ST段抬高型心肌梗死尿激酶溶栓失败后行补救性经皮冠状动脉介入治疗安全、有效。

Objective： To evaluate short-term efficacy and safety of routine emergency and remedial percutaneous coronary intervention （PCI） after failed urokinase thrombolysis in patients with acute ST-segment elevation myocar- dial infarction （STEMI）. Methods.. Basic data （including patients undergoing routine emergency and remedial PCI）, main endpoint events within 30d after PCI and occurrence of severe hemorrhage complications were retrospectively analyzed in all patients undergoing emergency PCI in our hospital from Jun 2006 to Dec 2009. Results.. A total of 134 patients underwent emergency PCI, among which 17 cases （12.68%） were transferred to our hospital for reme- dial PCI due to failed urokinase thrombolysis in other hospitals. Within 30d after PCI, there were seven cases （5.22 %） occurred main endpoint events and six cases （4. 48% ） died. Multiple factor Logistic analysis indicated that coronary artery TIMI blood flow ≤grade 1 was significantly correlated with main endpoint events （OR = 60.98, P 〈0.05）. There were three cases （2.24%） occurring severe hemorrhage complications. Single factor Logistic analy- sis indicated that severe hemorrhage complications were not significantly correlated with remedial PCI （P〉0.05 all）. Conclusion： It＇s safe and effective to perform remedial PCI after failed urokinase thrombolysis in patients with acute ST-segment elevation myocardial infarction.