冠状动脉支架植入术治疗急性心肌梗塞39例

Primary intracoronary stenting in 39 patients with acute myocardial infarction

目的 :小结采用直接冠状动脉支架植入术治疗 39例急性心肌梗塞患者的中期效果。方法 :接受介入治疗距胸痛发作的平均时间为 4 2h。经股动脉采用Judkins技术完成冠状动脉造影及支架植入术。在 38例患者 42支血管共植入 5 5个支架 ,1例患者仅行右冠状动脉球囊成形术。结果 :术后即刻TIMI血流 3级者 36例(92 3% ) ,TIMI血流 2级者 3例 (7 7% )。术中 6例 (15 4% )在梗塞相关动脉开通后出现心室颤动 ,1例(2 6 % )死于继发性心室颤动。术后平均随访 8 1个月 ,除 1例死于术后 2周非梗塞相关动脉择期支架植入术外 ,无心肌梗塞、做外科冠状动脉搭桥术和再次做梗塞相关动脉介入治疗的病例。结论 :直接冠状动脉支架术可以迅速获得梗塞相关动脉TIMI 3级血流 。

Objective:To describe the mid term result of primary intracoronary stenting in 39 patients with acute myocardial infarction.Methods:Coronary stenting was applied within an average 4 2 hours after onset of chest pain by using Judkins technique via femoral artery.Fifty five stents were implanted into 42 infarct related coronary arteries with a full procedural success rate.Results:Thrombolysis in myocardial infarction(TIMI)grade 3 flow was archived in 36 patients (92 3%), and TIMI grade 2 flow in three patients (7 7%).In the procedure, reperfusional arrhythmia ventricle fibrillation occurred in six patients (15 4%) while a patent infarct related artery was established,and another patient (2 6%) died of secondary ventricle fibrillation.Except one patient who died of acute coronary thrombosis secondary to elective coronary angioplasty for another non infarct related artery after two weeks,no myocardial infarction, coronary artery bypass grafting or repeat percutaneous transluminal coronary angioplasty of the infarct related vessel occurred during an average 8 1 months clinical follow up.Conclusion:Primary coronary stenting is an effective method in restoring TIMI grade 3 flow perfusion of the infarct related artery with a good mid term result.