急性胸痛患者行冠脉造影后未介入治疗的原因

Clinical Analysis of Acute Chest Pain Patients with no Further PCI Therapy after Coronary Angiography

目的:分析于德州市人民医院胸痛中心(CPC)就诊的急性胸痛患者行急诊冠脉造影术(CAG)后未行进一步介入治疗的原因.方法:回顾性分析2017-03至2020-03因急性胸痛于医院CPC就诊,拟诊为急性冠脉综合征(ACS)的患者,经绿色通道行急诊CAG后未进一步行介入治疗的原因.结果:自医院CPC运行以来,行急诊CAG后未行进一步介入治疗的胸痛患者共124例.确诊为ACS共114例,其中急性心肌梗死(AMI)97例,不稳定性心绞痛(UA)17例;应激性心肌病5例;肥厚型心肌病2例;心肌炎2例;主动脉夹层1例.确诊为ACS患者未行介入治疗的原因有冠脉痉挛(32例),血栓自溶(26例),微循环障碍(7例),三支病变行冠脉搭桥术(急诊手术9例,择期手术24例),因活动性出血转ICU治疗(2例),因血栓负荷过重行血栓抽吸术(2例),患者或家属拒绝进一步治疗(12例).结论:有多种不同的病变可导致患者发作急性胸痛,胸痛患者尽早行CAG检查可减少误诊率,及时得到正确有效的治疗.

Objective:To analyze the reason of no further interventional treatment after emergency coronary angiography for patients with acute chest pain in chest pain center(CPC)of our hospital.Methods:A retrospective analysis was made on the causes of acute chest pain as the first symptom in the CPC of our hospital from March 2017 to March 2020.The patients who were diagnosed as acute coronary syndrome did not receive further coronary intervention after emergency CAG through green channel.Results:Since the operation of CPC in our hospital,124 cases were not treated with further intervention after CAG.Among the 124 patients included in the study,114 were diagnosed as ACS,including 97 AMI,17 unstable angina;5 stress cardiomyopathy;2 hypertrophic cardiomyopathy;2 myocarditis;1 aortic dissection.The main causes of untreate d ACS patients were coronary spasm、thrombolysis、microcirculation disturbance、coronary artery bypass grafting therapy,with active hemorrhage transferred to ICU,and overload of thrombus aspiration was performed in 2 cases,and patients or their families refused further treatment in 12 cases.Conclusion:It is confirmed by CAG that there are many kinds of different illnesses can induce acute chest pain,Early CAG examination can reduce the misdiagnosis rate and make patients get effective treatment in time.