补救性冠状动脉成形术治疗老年人急性心肌梗死

Rescue angioplasty in failed thrombolysis in elderly patients with acute myocardial infarction (AMI)

目的 评价老年人急性心肌梗死 (AMI)溶栓失败后补救性冠状动脉成形术 (PTCA)的成功率 ,住院存活率及 6个月随访结果。方法 2 8例老年人 AMI,于发病 (胸痛 )开始 6h内接受静脉溶栓治疗 ,溶栓开始 90 min时行冠状动脉造影 ,示 TIMI(心肌梗死溶栓试验 )血流 0～ 1级或虽达 2级但仍有胸痛 ,立即给予急诊补救性 PTCA并记录其成功率、住院存活率 ,术后随访 6个月。结果 全部患者中梗塞相关动脉 (IRA) 31支 ,其中前降支病变 1 7支 ,右冠状动脉病变 1 0支 ,回旋支病变 4支 ,补救性 PTCA使 2 6例患者 IRA完全再通 ,成功率 92 .9% ,TIMI血流均达 3级 ,其中1 0例补救性 PTCA后因残余狭窄大于 50 %而植入支架。成功的补救性 PTCA患者住院存活率 96.3% ,1例死亡 ,术后随访 6个月 ,4例因胸痛复发经冠状动脉造影证实为再狭窄 (1 5.4% )。未成功的补救性 PTCA患者中 1例死亡 (死亡率 50 % )。结论 老年人 AMI溶栓失败后补救性 PTCA成功率及住院存活率高 。

? Objective To investigate the successful and survival rate of elderly patients undergoing rescue angioplasty in failed thrombolysis in AMI and the outcome at 6 month follow up.Methods 28 elderly patients (20 men and 8 women, age 65 to 73) with no evidence of reperfusion (TIMI 0～1 flow or 2 flow) after thrombolysis for AMI were performed rescue angioplasty. Their records were reviewed for the results of the stenosis degree of infarct related arteries (IRA), the successful and survival rate during the hospitalization and the restenosis rate during the follow up period about 6 months. Results In 28 cases with 31 IRAs, 26 cases have a successful rescue angioplasty (92.9%) and showed TIMI 3 flow, 10 cases received intracoronary stenting because of remained stenosis (>50%), the survival rate was 96.3% during the hospitalization for the successful angioplasty and 4 cases showed restenosis (15.4%) at 6 month follow up. Conclusion After failed thrombolysis, the elderly patients having a rescue angioplasty gain a higher successful and survival rate, and the long term prognosis was improved significantly.