急诊冠状动脉造影和经皮冠状动脉腔内成形术治疗急性心肌梗死100例临床研究

Clinical Study of Coronary Arteriography and Percutaneous Transluminal Coronary Angioplasty in 100 Patients with Acute Myocardial Infarction

目的:分析急性心肌梗死(AMI)的急诊冠状动脉造影结果,观察经皮冠状动脉腔内成形术(PTCA)或PTCA+支架治疗AMI的近期疗效。方法:将符合条件的AMI患者100例行急诊冠状动脉造影,明确梗死相关血管(IRA),对TIMI血流O～I级的86例患者行直接PTCA或PTCA+支架,观察住院期间死亡率,心脏急性事件发生及并发症。结果:100例患者中单支血管病变19例(19%),双支血管病变27例(27%),三支血管病变47例(47%),左主干病变7例(7%),有侧支循环32例(32%),有钙化43例(43%)。IRA共113支,其中前降支50支,回旋支11支,右冠状动脉52支。15支IRA TIMI血流Ⅲ级未干预,对98支IRA行PTCA或PTCA+支架,7例仅行PTCA,全部获得再通;91支PTCA+支架中88支获得完全再通,前向血流TIMI Ⅲ级,成功率96.9%。PTCA或PTCA+支架成功组住院期间无死亡发生,4例(4.8%)有不稳定心绞痛发生。未行PTCA或PTCA不成功组2例死亡(11.8%),12例有不稳定性心绞痛发生(70.5%)。两组相比差异具有显著性(P<0.05)。结论:急诊PTCA成功率高,住院期间并发症少,心脏急性事件发生少。

Purpose: To analyse the results of coronary arteriography(CAG) and assess the early clinical efficacy of emergency percutaneous transluminal coronary angioplasty( PTCA) or stenting in patients with acute myocardial infarction( AMI). Methods: CAG were performed in 100 patients with AMI and determined the infarct related arteries (IRA). 86 cases without obvious evidence of reperfusion (TIMI 0 ~ I flow) were treated with emergent PTCA and/or stenting. Cardiac emergent events and complications were recorded during hospitalization. Results: There were 19 cases( 19% ) of single - vessel disease ,27 cases(27% ) with double vessal disease ,47 cases(47% ) of three - vessel disease and 7 cases (7% ) were of left main coronary artery lesion,collateral circulation present in 32 cases(32% ) .calcification in 43 cases (43% ). There Were 113 infarct related arteries in 100 cases ,50 cases of left anterior descending branches, 11 cases of left circumflex branches and 52 cases of right coronaries. 7 cases of IRAs treated with PTCA and 88 cases of 91 IRAs with PTCA and stenting in 98 IRAs without obvious evidence of reperfusion (TIMI 0 ~1 flow) acquiring repatency(96. 9% ) ,15 cases of IRAs(TIMI III flow) without treatment. There was no inhospital mortality and 4 cases unstable angina in PTCA or PTCA and stenting, 2 death (11.8%) and 12 unstable angina in no PTCA ( P < 0. 05 ) . Conclusion:Successful rate of emergent coronary angioplasty increaced, complications and cardiac events reduced in hospitalized patients.