经皮桡动脉冠脉介入治疗急性心肌梗死的临床研究

Clinical study on coronary intervention transradial approach in the treatment of acute myocardial infarction

目的 探讨经皮桡动脉入路冠脉介入治疗急性心肌梗死的临床应用及预后随访.方法 收集2008年7月至2014年5月苏州市立医院确诊的急性心肌梗死患者179例,其中经皮桡动脉入路介入治疗107例（TRI组）,经皮股动脉入路介入治疗72例（TFI组）.观察两组的穿刺成功率、PCI成功率、手术总时间、穿刺点并发症情况,以及随访3个月预后情况.结果 TRI组107例患者中,前壁心梗47例,下壁心梗39例,其他21例;单支病变24例,双支病变34例,三支病变49例.TFI组72例患者中,前壁心梗27例,下壁心梗29例,其他16例;单支病变12例,双支病变20例,三支病变40例.TRI组和TFI组穿刺成功率分别为97.2％和100％,P=0.401;PCI成功率分别为89.7％和95.8％,P=0.135;手术总时间分别为（79.4±32.0）min和（78.8±33.3）min,P=0.911.术后3个月的随访临床结果显示,MACE事件发生率TRI组较TFI组低.结论 经皮桡动脉直接冠脉介入治疗急性心肌梗死同经皮股动脉一样有着较高的手术成功率,且并发症较少,是急性心肌梗死介入治疗的最佳入路途径.

Objective To study the feasibility, safety, and follow-up outcomes of coronary intervention via transradial access for acute myocardial infarction. Methods We prospectively enrolled 179 patients with AMI during July 2008 to May 2014, of which transradial approaeh（TRI group） percutaneous coronary intervention（PCI） was used in 107patients, and the transfemoal approach（TFI group） was used in 72 patients. The successful rates of puncture procedure and PCI, the total procedure time, and local puncture complications were compared between the 2 groups. Results In TRI group, there were 47 patients had anterior infarction, 39 patients had inferior infarction, 24 patients had single vessel disease, 34 patients had double vessel disease. In TFI group, there were 27 patients had anterior infarction, 29 patients had inferior infarction, 12 patients had single vessel disease, 20 patients had double vessel disease. The successful rates of puncture procedure were 97.2%, 100% respectively, P= 0.401, and the successful rates of PCI were 89.7%, 95.8% respectively, P=0.135. The total procedure time were in group TRI and group TFI （79.4＋32.0）min vs （78.8：t：33.3）min, P=0.911. Clinic outcomes of three months follow-up after operation, the incidence of MACE were lower in TRI than these in TFI group. Condution The transradial approach is a feasibility, attractive alternative access site for performing percutaneous coronary intervention in treatment for patients with acute myocardial infarction. So transradial approach intervention therapy maybe the best choose for acute myocardial infarction patients.