急性冠状动脉综合征患者经皮冠状动脉介入治疗围术期死亡原因分析

目的：探讨急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）围术期死亡原因。方法：2002年1月—2006年3月在复旦大学附属中山医院接受PCI的3 806例冠心病患者中36例ACS患者发生围术期死亡。其中男性23例,女性13例;年龄24~85岁（平均年龄69±23岁）,包括急性心肌梗死（AMI）29例、不稳定心绞痛7例,其中既往有陈旧性心肌梗死史者7例、PCI治疗史者4例、冠状动脉旁路移植术（CABG）史者1例、脑卒中史者4例,合并有高血压病者20例、脂代谢紊乱者11例、糖尿病者6例、慢性阻塞性肺病者4例。结果：36例ACS患者中,因AMI行急诊PCI者24例,ACS行择期PCI者12例（包括AMI5例、不稳定心绞痛7例）。冠状动脉造影显示,26例有2支及以上多支血管病变,10例为单支血管病变。36例ACS患者PCI围术期死亡原因为心力衰竭或（和）心源性休克16例（44.4%）,室颤和（或）心脏骤停8例（22.2%）,多脏器功能衰竭4例（11.1%）,心脏破裂4例（11.1%）,急性或亚急性支架内血栓形成3例（8.3%）,消化道大出血1例（2.8%）。急诊PCI因泵衰竭死亡的12例患者中,广泛前壁AMI7例、下壁＋后壁AMI3例,下壁＋右室AMI2例。结论：ACS患者PCI围术期死亡的主要原因为泵衰竭、室颤和（或）心脏骤停、多脏器功能衰竭、心脏破裂及支架内血栓形成。

Perioperative Death Causes in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Objective：To analyze the causes of perioperative death in patients with acute coronary syndrome（ACS） undergoing percutaneous coronary intervention（PCI）.Methods：The clinical data of 36 perioperative death patients with ACS from 3086 coronary heart disease patients undergone PCI during January 2002 through March 2006 were analyzed retrospectively.The patients（23 males,13 females,aged 69±23 years old） included 29 cases of acute myocardial infarction and 7 cases of unstable angina,with a history of previous myocardial infarction in 7 patients,PCI in 4 patients,coronary artery bypass graft in 1 patient,and stoke in 4 patients.Results： Among 36 patients who died in perioperative period 24 were AMI patients undergone emergent PCI and 12 were ACS patients received early PCI.On angiography,coronary multi-vessel disease（≥2 vessels） was found in 26 patients,single vessel disease in 10 patients.Of all the patients,16 patients（44.4%） died from cardiogenic shock and/or heart failure,8 patients（22.2%） from ventricular fibrillation/cardiac arrest,4 patients（11.1%） from multi-organ failure,4 patients from cardiac rupture,3 patients（8.3%） from acute or sub-acute coronary in-stent thrombosis,and 1 patient（2.8%） from gastrointestinal bleeding.Of 12 patients died from cardiac pump failure after emergent PCI,7 patients were of massive anterior myocardial infarction,3 patients of inferior and posterior infarction,and 2 patients of inferior and right ventricular infarction.Conclusions： The main causes of peri-PCI death in patients with ACS are left ventricular pump failure,ventricular fibrillation/cardiac arrest,multi-organ failure,cardiac rupture and in-stent thrombosis.