直接冠状动脉内支架置入术治疗急性心肌梗死30例疗效分析

An evaluation of the clinical efficiency of direct coronary stenting without predilatation for 30 cases of acute myocardial infarction

目的 :观察急性心肌梗死 (AMI)病人 ,在无球囊预扩张情况下 ,直接置入冠状动脉内支架治疗的疗效及其再狭窄的探讨。方法 :对 30例AMI病人在发病 12h内 ,未经球囊预扩张采用直接置入冠状动脉内支架。观察梗死相关血管开通成功率、TIMI血流Ⅲ级发生率、出院时左心室功能、住院死亡率 ,术后 6个月再狭窄率、死亡率、左心室功能情况。结果 :直接置入冠状动脉内支架 30个 ,梗死相关血管开通成功率为 10 0 % ,TIMI血流Ⅲ级 2 9例 (96 .7% ) ,TIMI血流II级者 1例 (3.3% ) ,术后残余狭窄为 4 .5± 3.0 %。出院时左心室射血分数 (LVEF)为 5 6 .5 %± 11.2 % ,住院死亡率 3.3% (1例 )。术后 6个月再狭窄率为 12 .5 % ,无 1例死亡、左心室射血分数 (LVEF)为 5 8.2 %± 9.8%。结论 :急性心肌梗死 (AMI)时 ,在无球囊预扩张情况下 ,直接置入冠状动脉内支架治疗 ,梗死相关血管开通成功率较高 ,TIMI血流Ⅲ级发生率高 ,能降低死亡率及致残率。

Objective: To study the therapeutic effects of direct coronary stenting without predilatation in acute myocardial infarction (AMI).Methods:The 30 cases of AMI was treated by direct coronary stenting without predilatation.We have observed the successful rate of reperfusion in infarction-involving blood vessels,with 3 grade flow of TIMI,and the left ventricular function (LVEF) up to the patients′discharge from hospital,hospitalization death rate, and restenosis rate ,death rate, LVEF six months later as well. Results: The successful rate of reperfusion in infarction-involving blood vessels was 100%, 29 cases(96.7%)were with TIMI III blood flow,1 cases was with TIMI II blood flow, the LVEF was 56.5%±11.2%, hospitalization death rate was 3.3%(1case),Post-stenting residual stenosis decreased to 4.5±3.0%.Six monthes later: restenosis rate 12.5%, none of death , LVEF 58.2%±9.8%. Conclusion:Direct coronary stenting without predilatation for AMI can improve the successful rate of reperfusion in infarction-involving blood vessels and TIMI III blood flow rate, lower the death and disabled rate.