急性心肌梗死后的延迟冠状动脉内支架植入治疗

Delayed coronary stenting of infarct-related artery in patients with myocardial infarction

目的 评估急性心肌梗死后梗死相关冠状动脉内支架植入的临床疗效。方法 15 4例急性心肌梗死患者 ,平均年龄 (6 1± 12 )岁于发病后平均 13天行冠状动脉内支架术 ,所有患者常规服用肠溶阿司匹林和噻氯匹定。观察住院期和随访期的临床事件。结果 15 4例患者共植入 173个支架 (平均 1 1个 /例 )。支架植入的指征 :选择性初发病变 (denovo)占 2 4 3 % ,急性或濒危闭塞占13 9% ,有发生闭塞高危因素的病变占 6 1 8%。所用支架主要为Nir支架 (2 6 % )、Multi Link支架(19% )、XT支架 (13% )、Crossflex支架 (10 % ) ,等等。支架植入时最大球囊充盈压力为 (12± 2 )大气压。平均残余狭窄 (7± 8) %。住院期间无一例死亡、心肌梗死和需重复再通治疗 ,但术后“微坏死(micronecrosis)”率为 1 3%。术后 6个月病死率为 3 9% ,Q波型或非Q波型心肌梗死率为 1 9% ,支架内再狭窄而行再次冠状动脉腔内成形术率 6 1%。总的无心脏事件存活率为 89 6 %。结论 心肌梗死后行冠状动脉内支架术是安全的 ,并能改善患者的近期预后 ,但其远期疗效尚需进一步研究。

Objective To evalute the safety and efficacy of coronary stenting for infarct-related artery in postinfarctional patients. Methods One hundred and fifty-four consecutive patients with a first acute myocardial infarction underwent PTCA and coronary stenting with an average of 13 days after the acute event. Antithrombotic therapy with aspirin and ticlopidine was routinely used in all patients. Cardiac events including death, Q-wave or non-Q-wave myocardial infarction, and repeated target lesion revascularization during hospitalization and follow-up were recorded. Results One hundred and seventy-three stents were implanted (1 1 stents/patient). The indication for stent implantation was elective in 24 3%, acute or imminent closure in 13 9%, lesion with threatened closure in 61 8%. The following different stents were used: Nir stents (26%), Multi-Link stents (19%), XT stents (13%), Crossflex stents (10%), AVE stents (8%), Bestent stents and Palmaz-Schatz stents (6% in each), together with Gianturco-Roubin Ⅱ stents, Wiktor stents, Jostent stents, Inflow stents and Devon stents (12%). The mean pressure of balloon inflation during stent deployment was (12±2) atm. The mean residual stenosis was (7±8)%. There was no death, Q-wave or non-Q-wave myocardial infarction and repeated recanalizations during the hospitalization, but the rate of micronecrosis after stenting was 1 3%, determined by an increase in plasma level of CK or CK-MB or troponin T. Adverse events during six-month follow-up showed a mortality rate of 3 9%, Q-wave or non-Q-wave myocardial infarction occurred in 1 9% of patients. 6 1% of patients experienced restenosis and all underwent repeated PTCA. The total rate of free-event survival was 89 6%. Conclusion Coronary stenting of infarct-related artery during healed phase of acute myocardial infarction is effective and safe under the antithrombotic therapy.