老年急性心肌梗死患者冠状动脉内支架置入术的临床评估

Clinical evaluation of coronary stenting in elderly patients after acute myocardial infarction

目的 评价老年急性心肌梗死 (AMI)患者梗死相关动脉支架置入术的疗效及安全性。方法 对35例年龄≥ 70岁的老年急性心肌梗死患者在发病 12h以内行梗死相关动脉直接经皮冠状动脉腔内成形术(PTCA)加冠状动脉内支架置入术。梗死相关动脉 :前降支 18例 (5 1.4 % ) ,回旋支 8例 (2 2 .9% ) ,右冠状动脉9例 (2 5 .7% )。心肌梗死溶栓治疗临床试验 (TIMI)血流 :0级 9例 ,Ⅰ级 16例 ,Ⅱ级 10例。结果 35例患者中 34例介入治疗成功 (成功率 97.1% ) ,梗死相关动脉共置入支架 4 1个 ,术中无死亡发生。术后TIMI血流 3级为 32例 (91.4 % )。术后第 2天死亡 1例 ,死于脑出血。临床总成功率为 94 .3% (33/ 35 )。随访 32例 ,1例出现心绞痛 ,冠状动脉造影示再狭窄 ,行PTCA加冠状动脉内支架置入术 ;2例出院后因心力衰竭再次入院治疗 ;其余 2 9例未再发生心绞痛。结论 急诊PTCA加冠状动脉内支架置入术对老年AMI患者具有理想的即刻和长期疗效。合理选择器械、操作技术熟练和围手术期并发症处理经验是保证老年急诊PTCA加冠状动脉内支架置入术获得高成功率的 3个关键。

Objective: To evaluate the clinical efficacy of primary intracoronary stenting in the infarct related artery in elderly patients after acute myocardial infarction(AMI).Methods: Percutaneous transluminal coronary angioplasty (PTCA) plus primary coronary stenting was performed for 35 AMI patients( ≥70 years) within 12 hours from the onset of chest pain. Infarct related arteries were left anterior descending artery in 18 patients (51.4%), left circumflex in 8(22.9%), right coronary artery in 9(25.7%). Thrombolysis in myocardial infarction (TIMI) showed that blood flow was grade 0 in 9 patients, grade 1 in 16,grade 2 in 10.Results:34 patients were successfully treated by emergency PTCA and the rates of successful treatment were 97.1%. 41 stents were implanted in the infarct related artery for 34 patients. one patient died of cerebral hemorrhage while hospitalizing. Grade 3 of blood flow after TIMI was gained in 32 patients(91.4%). The clinical successful rate was 94.3%(33/35). 32 patients were followed up, One patient with restenosis of infarct related artery was performed PTCA plus primary coronary stenting, and 2 patients with congestive heart failure were rehospitalized. Other 29 patients did not manifested angina pectoris. Conclusions:The emergency coronary stenting has immediate and long term satisfactory therapeutic efficacy for the elderly with AMI. The following three factors are the key to ideal efficacy: proper devices chosen, skillful manipulation and experience for managing peri-operation complications.