急诊冠状动脉介入治疗急性心肌梗死的临床研究

EMERGENT PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ACUTE MY-OCARDIAL INFARCTION

目的 通过回顾性分析,探讨急诊经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)的安全性和治疗效果。方法 我院收治的ST段抬高的急性心肌梗死患者,发病时间在12h内,行急诊冠状动脉造影、急诊PCI和支架植入术。如果梗死相关血管(IRA)前向血流为TIMI 0-2级或虽达到TIMI 3级,但残余狭窄≥90％者采取急诊PCI治疗。结果 入选急性心肌梗死患者119例行急诊冠状动脉造影,男82例,女37例,年龄35-86岁,平均(58.8±12.7)岁,冠状动脉造影显示:IRA为前降支72例;右冠状动脉为43例;回旋支为4例。110例患者IRA行球囊扩张和支架植入,有7例患者行球囊扩张后残余狭窄<20％,TIMI 3级,未进一步行支架置入。行PCI的117例患者,成功率98.8％,IRA的前向血流达到TIMI 3级的达95.4％。随访30d,95例患者(80％)无事件生存,住院期间死亡5例,发生急性和亚急性闭塞5例。结论 急性心肌梗死行紧急PCI,疗效明显且安全,应在有条件的医院大力开展,推广应用。

Objective To evaluate the safety and effectiveness of percutaneous coronary intervention in patients with acute myocardial infarction(AMI). Methods From May 2001 to Oct. 2003,119 patients with ST-elevation acute myocardial infarction within 12 hours from onset, were performed e-mergent angiography. Patients with infarct related-arteries blood flow TIMI 0-2 and stenosis more than 90% underwent PTCA and stenting. Results Of the patients, there were 82 males and 37 females, aged from 35 to 86 years old. Infarct related - arteries were LAD in 72,RCA in 43 and LCX in 4 patients. Procedure successful rate was 98.8% and 95.4% gained TIMI 3 blood flow. The coronary stent were implanted in 110 cases. With 30 days follow - up,95 patients(80%) were events free. 5 patients died,during hospitalization. 5 patients occurred acute and subacute thrombosis. Conclusion E-mergent percutaneous coronary intervention is a safe and effective therapy for AMI.