直接经皮腔内冠状动脉成形术治疗急性前壁心肌梗死及其临床预后

The clinical outcomes of patients with anterior wall acute myocardial infarction treated by primary percutaneous transluminal coronary angioplasty

目的 :探讨直接经皮腔内冠状动脉成形术 (PTCA)治疗急性前壁心肌梗死 (前壁 AMI)及其临床预后。方法 :连续行急诊冠状动脉 (冠脉 )造影及直接 PTCA的前壁 A MI患者 142例 ,分析其冠脉病变特点、直接PTCA的治疗效果及住院期与随访期主要心血管事件发生率。结果 :142例前壁 AMI中伴心源性休克 11例 ,溶栓失败后补救 PTCA 16例 ,冠脉造影示单支病变 75例 (5 2 .8% ) ,多支病变 6 7例 (4 7.2 % ) ,梗死相关血管 95 .8%为前降支。PTCA成功者 139例 (97.89% ) ,130例置入冠脉内支架 139个。住院期非致命性心力衰竭 10例 ,死亡 5例 (死于心源性休克 )。对 12 2例患者平均随访 (17.3± 9.8)月 ,非致命性再次心肌梗死 2例 ,靶血管再次血运重建 9例 ,心脏性死亡 3例。结论 :直接 PTCA对前壁 AMI患者的治疗是安全有效的 。

Objective:To investigate the cl in ical outcomes of patients with anterior wall acute myocardial infarction(AMI) tr eated by primary percutaneous transluminal coronary angioplasty (PTCA).Method:The characteristics of coronary artery lesion, effi cacy of primary PTCA and major cardiovascular events during follow-up were anal ysed in 142 patients with anterior wall AMI consecutively performed emergency co ronary angiography and primary PTCA. Result:Out of 142 cases, there were 11 patients complicat ed with cardiac shock and 16 patients with rescue-PTCA following failure of thr ombolysis.Angiogram showed 75 cases with single vessel disease ( 52.8%) and 6 7 case with multi-vessel disease ( 47.2%) and indicated that 95.8% of in farction-related artery (IRA) was left anterior descending coronary artery. Pr ocedure of PTCA for 139 cases was successful (success rate was 97.89%), in w hich 139 coronary stents were implanted in 130 patients. In-hospital period, 10 patients complicated non-fatal congestive heart failure and 5 patients died fr om cardiac shock. During a mean ( 17.3± 9.8) months follow-up in 122 pat ients, 2 cases suffered from non-fatal AMI, 9 cases for target vessel revascula rization and 3 cases for cardiac death.Conclusion:Primary PTCA is a safe and effective treatment for patients with anterior wall AMI and c an improve the clinical outcomes of these high risk patients.