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老年急性心肌梗死患者溶栓后补救性冠状动脉介入治疗的临床研究
引用本文:王禹,盖鲁粤,杨庭树,李天德,沈宏,计达,陈练,任艺虹,苏绍萍. 老年急性心肌梗死患者溶栓后补救性冠状动脉介入治疗的临床研究[J]. 中华老年心脑血管病杂志, 2005, 7(2): 85-87
作者姓名:王禹  盖鲁粤  杨庭树  李天德  沈宏  计达  陈练  任艺虹  苏绍萍
作者单位:解放军总医院,北京,100853
摘    要:
目的 评价老年急性ST段抬高性心肌梗死患者,在急诊静脉溶栓治疗后,对于梗死相关冠状动脉未能有效开通的病例,进行补救性冠状动脉介入治疗。方法 ≥70岁急性ST段抬高的心肌梗死(ST segmentelevationacutemyocardialinfarction ,STE AMI)患者5 2例(≥70岁组) ,在急诊静脉溶栓治疗后若判定梗死相关动脉未能有效开通,则即行冠状动脉造影,若造影显示梗死相关动脉血流为非TIMI 3级灌注、同时患者仍有较明显胸痛和(或)梗死对应心电图导联ST段抬高,并除外急诊冠状动脉介入治疗的禁忌证,即进行梗死相关冠状动脉的补救性介入治疗(包括球囊扩张、支架置入)。同时与<70岁的6 7例(<70岁组)STE AMI患者进行比较。结果 与<70岁组患者比较,≥70岁组的STE AMI患者在进行了静脉溶栓治疗后行急诊冠状动脉造影显示:溶栓有效开通比例低,同时在心肌梗死急性期的死亡绝对数较大;但梗死相关动脉经皮冠状动脉介入治疗(PCI)成功比例两组无差异,同时,在≥70岁组,接受了静脉溶栓治疗后,再行PCI的严重出血并发症(包括颅内出血、消化道大出血等)并未见增加。结论 ≥70岁组患者静脉溶栓有效开通比例较低,进行补救性PCI成功比例与<70岁组的STE AMI患者相同,在严密监测出、凝血参数情况下出现严重出血并发症低。

关 键 词:心肌梗塞  血栓溶解疗法  放射摄影术,介入性  支架
文章编号:1009-0126(2005)02-0085-03
收稿时间:2004-11-02
修稿时间:2004-11-02

Clinical study of rescue PCI after thrombolysis for elderly patients with acute ST-segment elevation myocardial infarction
Wang Yu;Gai LuYue;Yang TingShu;Li TianDe;Shen Hong;Ji Da;Chen Lian;Ren YiHong;Su ShaoPing. Clinical study of rescue PCI after thrombolysis for elderly patients with acute ST-segment elevation myocardial infarction[J]. Chinese Journal of Geriatric Cardiovascular and Cerebrovascular Diseases, 2005, 7(2): 85-87
Authors:Wang Yu  Gai LuYue  Yang TingShu  Li TianDe  Shen Hong  Ji Da  Chen Lian  Ren YiHong  Su ShaoPing
Abstract:
Objective To evaluate the efficacy and the safety of rescue-PCI after the failure of intravenous thrombolysis in elderly with ST-segment elevation acute myocardial infarction(AMI).Method 119 consecutive patients with ST-segment elevation AMI after the failure of intravenous thrombolysis were analysed, including 52 aged patients (≥70 years old) and 67 non-aged patients (<70 years old) undertaking the rescue-PCI, following confirmation of non-TIMI-Ⅲ perfusion(TIMI-0-TIMI-Ⅱ) with the 90min coronary angiography after intravenous infusion thrombolysis. The immediate results and in-hospital outcomes were compared between the two groups.Results Procedural success rate(96.6% vs 98.7%,P>0.05) and emergency CABG and mortality rate had no significant statistic differences between the two groups.However,the group of elderly patients presented higher absolute mortality (4 vs 0). There was no difference in severe hemorrhage between the two groups.Conclusion The rescue-PCI for the elderly STE-AMI patients following the intravenous thrombolysis failure showed satisfactory effectiveness, reliable outcome and little severe fatal hemorrhage. The follow-up observation is needed for long-term prognosis.
Keywords:myocardial infarction   thrombolytic therapy   radiography, interventional   stents
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