老年人急性心肌梗死直接经皮冠状动脉腔内成形术的治疗体会

目的评价老年人急性心肌梗死(AMI)直接经皮冠状动脉腔内成形术(直接PTCA)的成功率及有效性。方法42例发病在0．5～10h的老年AMI患者接受了直接PTCA,术后随访半年。结果40例患者中的45支梗塞相关血管(IRA)获得再通．成功率达95．2％(40/42),均达到TIMI-3级血流灌注,再通血管残余狭窄0％～20％。5例合并左心功能不全(Killip分级Ⅱ～Ⅲ级)及3例合并心源性休克患者术后症状明显改善,住院期间1例死亡(病死率2．5％)。术后随访半年,6例直接PTCA成功患者(15．0％)心绞痛复发,再次PTCA后血管再通。结论直接PTCA治疗老年人AMI成功率高,病死率低,近期预后良好,是一种安全有效的治疗方法。     

老年人急性心肌梗死直接经皮冠状动脉腔内成形术的治疗体会

目的评价老年人急性心肌梗死（ＡＭＩ）直接经皮冠状动脉腔内成形术（直接ＰＴＣＡ）的成功率及有效性。方法４２例发病在０．５～１０ｈ的老年ＡＭＩ患者接受了直接ＰＴＣＡ,术后随访半年。结果４０例患者中的４５支梗塞相关血管（ＩＲＡ）获得再通,成功率达９５．２％（４０／４２）,均达到ＴＩＭＩ－３级血流灌注,再通血管残余狭窄０％～２０％。５例合并左心功能不全（Ｋｉｌｉｐ分级Ⅱ～Ⅲ级）及３例合并心源性休克患者术后症状明显改善,住院期间１例死亡（病死率２．５％）。术后随访半年,６例直接ＰＴＣＡ成功患者（１５．０％）心绞痛复发,再次ＰＴＣＡ后血管再通。结论直接ＰＴＣＡ治疗老年人ＡＭＩ成功率高,病死率低,近期预后良好,是一种安全有效的治疗方法。     

老年急性心肌梗死溶栓后补救性冠状动脉介入治疗的临床研究

目的:评价老年急性ST段抬高性心肌梗死病人,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人,进行补救性冠状动脉介入治疗的有效性、安全性及可能出现的特殊问题。方法:按照病人年龄分为≥70岁组(n=52)和<70岁组(n=67)2组,对于≥70岁组急性ST段抬高性心肌梗死病人,在急诊静脉溶栓治疗判定未能有效开通后,则即行冠状动脉造影,若造影显示梗死相关动脉血流为非心肌梗死溶栓治疗临床试验(TIMI)3级灌注、同时病人仍有较明显胸痛,和(或)梗死对应心电图导联ST段仍抬高,并除外急诊冠状动脉介入治疗的禁忌证,则即进行梗死相关冠状动脉的补救性介入再通治疗(包括球囊扩张、支架置入)。同时与<70岁组的ST段抬高性心肌梗死病人进行比较。结果:与<70岁组比较,≥70岁组在进行了静脉溶栓治疗后的急诊冠状动脉造影显示:溶栓有效开通比例低,同时在急性心肌梗死急性期的死亡绝对数较多;但梗死相关冠状动脉血管的介入治疗成功比例两组无差别,同时,在≥70岁组,接受了静脉溶栓治疗后,再行介入治疗的严重出血并发症(包括颅内出血、消化道大出血等)也未见显著增加。结论:≥70岁组急性心肌梗死病人,静脉溶栓有效开通比例较低,进行补救性冠状动脉介入成功比例与<70岁组相同,严密监测出、凝血参数,出现严重出血并发症低。     

尿激酶加补救性冠状动脉介入治疗术对急性心肌梗死的疗效研究

本研究以直接经皮冠状动脉介入治疗(percutaneous coronary intervention，PCI)为对照，观察尿激酶溶栓加挽救性PCI治疗急性心肌梗死(acute myocardial infarction，AMI)的临床疗效，旨为AMI的再灌注治疗提供更多的选择。     

急性心肌梗死经皮冠状动脉成形术治疗的近期疗效

目的：观察急性心肌梗死（AMI）经皮冠状动脉成形术（PTCA）及原发性冠状动脉内支架植入术的近期疗效。方法：204例AMI患发病0．5－26h内行急诊冠状动脉造影（CAG）,证实冠状动脉闭塞,仅对梗死相关血管直径行TPCA及原发性冠状动脉内支架植入,。结果：全组204例患再通197例,成功率96％,发病至血管再通的时间1－27h,平均5．6h,PTCA失败7例,其中心包填塞2例,钢丝不能通过2 ,术中死亡2例（均发生在伴有心源性休克的前壁心肌梗死患）,率为0．9％,5周内死亡2例（经PTCA及支架植入术后心功能未明显改善,死亡心功能不全）,2－6个月死亡6例（因再发心肌梗死而死亡,总死亡率4．9％。结论：AMI后早期（6h内）成功的再灌注可挽求涉死的心肌,缩小梗死面积和明显降低死亡率,即使 在较晚时间（＞12h),病人仍有胸痛及ST段抬高,使梗死的血管再通仍可达到治疗的目的。早期充分的再灌注可明显改善患的预后,急诊TPCA治疗,可命名开通闭塞血管的届时时间提前,PTCA后残余狭窄甚微,再灌注血流充分,极少发生恢复期心肌缺务及心功能不全,在条件的大型A,TPTCA治疗AMI的最佳方法。     

血栓抽吸导管在急性心肌梗死补救性经皮冠状动脉介入治疗中的应用

急性ST段抬高型心肌梗死(STEAMI)患者直接经皮冠状动脉介入术(PCI)应用血栓抽吸导管可显著改善减少"无复流"发生率,可明显改善血流,改善心肌灌注,不增加主要心脏不良事件的发生率,但对于STEAMI溶栓失败行补救PCI这部分患者应用血栓抽吸导管的研究很少,本文通过应用血栓抽吸导管辅助急诊补救性PCI治疗STEAMI,观察其对无复流现象的治疗效果及临床心血管事件的影响.     

冠状动脉造影正常的老年人急性心肌梗死1例

1临床资料 患者,男,72岁.因持续性胸骨后压榨性剧烈疼痛5h人院.2003年7月6日晨无明显诱因出现胸骨后压榨性剧烈疼痛难忍,大汗淋漓,恶心、呕吐,呕吐物为胃内容物.急查心电图示;Ⅱ、Ⅲ、aVF ST段抬高0.1～0.2mV,Ⅱ、aVF呈R型,Ⅲ呈RS型,T波高尖.     

急性心肌梗死溶栓治疗失败后补救性PCI治疗临床观察

急性心肌梗死是心内科常见病 ,多发生心源性休克、心律失常、心功能不全等多种并发症。静脉溶栓治疗即可使 60 %～65 %的病人在 90min内恢复TIMI 3级血流[1] ,且无需特殊设备 ,短时间内即可使用。在临床上 ,尤其是基层医院由于人员和设备的限制 ,不能很快做经皮冠状动脉介入治疗 (PCI) ,溶栓治疗仍为首选 ,但溶栓失败率仍有 3 5 %～ 40 % ,现就溶栓治疗失败后进行补救性PCI治疗 ,疗效情况报道如下。1　资料与方法1.1　临床资料　随机抽取我院 1998年— 2 0 0 2年因急性心肌梗死住院病人进行溶栓治疗的 82例 ,溶栓未成功者 2 9例 ,未进行…     

急性心肌梗死溶栓失败后补救性PTCA的评价

溶栓失败后立即PTCA即补救性或挽救性(rescue或salvage)PTCA。     

急诊经皮腔内冠状动脉成形术治疗急性心肌梗死

目的 :观察急诊经皮腔内冠状动脉成形术 (PTCA)治疗急性心肌梗死 (AMI)的效果。方法 :13例 AMI患者行急诊 PTCA治疗 ,男 10例 ,女 3例 ,年龄 38～ 85 (6 0 .2± 13.6 )岁。其中 6例并发心源性休克 ,3例系溶栓失败后行补救性 PTCA,4例不适作溶栓治疗。梗死相关血管 :前降支 9例 ,右冠状动脉 4例。结果 :PTCA成功率92 .3% ,死亡 1例。术前梗死相关血管狭窄 (98.7± 3.0 ) % ,术后残余狭窄为 (14.6± 16 .2 ) %。 3例术中发生心室颤动 ,1例出现房室传导阻滞 ,1例出现无再流现象 ,经反复冠状动脉内注射硝酸甘油后恢复。术后 1例死亡 ,11例长期生存 ,随访 1～ 18个月无心脏事件发生 ,生活质量明显改善。结论 :AMI时行急诊 PTCA成功率高 ,对溶栓禁忌证、溶栓失败或 AMI并发心源性休克者应积极行急诊 PTCA。     

老年急性心肌梗死合并心衰的康复

研究对象为急性心肌梗死合并心衰的老年患者13例.年龄60～80(68士5.94)岁.左室射血分数33%～50%(40.61%士6.23%).10例采用福建省老年医院的4周康复程序,3例采用泉州市第一医院的2周康复程序.程序结束时7例完成踏车试验(功率50～100W),2例活动平板运动试验达到Bruce 3级,4例能上、下3层楼或步行300m.结果提示急性心肌梗死合并心衰(心衰基本控制)的老年患者在严密监护下进行康复医疗是安全、有益的.     

青年人及老年人急性心肌梗死直接经皮冠状动脉腔内成形术的特征

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Coronary stenting for failed angioplasty in acute myocardial infarction

Intracoronary stents were implanted in 15 patients after unsuccessful PTCA in the setting of acute myocardial infarction (AMI). The stented vessel was the left anterior descending (LAD) in 11 patients, the right coronary artery (RCA) in 3 patients, and a venous bypass graft to the LAD in a single patient. A total of 16 stents were implanted (15 Palmaz-Schatz, Johnson and Johnson; and 1 Wiktor, Medtronic). Follow-up: 1 patient died 10 days after stent implantation as a result of renal failure and cardiogenic shock. Subacute thrombosis occurred in 2 patients, 5 and 15 days after stent implantation; both underwent successful emergency coronary artery bypass grafting (CABG). The remaining 12 patients were free from major ischemic events (death, AMI, and further revascularization) after a mean follow-up of 18.7 ± 4.1 months. We conclude that the long-term results of intracoronary stenting in AMI after failed PTCA are favourable. © 1996 Wiley-Liss, Inc.     

Time delay in the treatment of acute myocardial infarction (AMI): a comparison of primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolysis

Abstract Background: If primary percutaneous transluminal coronary angioplasty (PTCA) cannot be performed within times comparable to thrombolysis, the possible advantages of that management may be offset by the logistic difficulties associated with its delivery.
Aim: To measure and compare the time delay involved in administration of thrombolysis and primary PTCA over a one year period and examine causes for delay greater than 60 minutes.
Method: Prospective data collection on all patients treated with primary PTCA or thrombolysis. A quality improvement process was applied.
Results: Eighty-five patients were treated with thrombolysis with a delay of 39±8 (SD) minutes, 12 patients being treated more than 60 minutes after presentation. Primary PTCA was used in 79 patients with a delay of 48±12 (SD) minutes, 21 patients being treated after more than 60 minutes. Time delays in the two management groups were significantly different (p=0.03) but that in primary PTCA during routine hours was not significantly different from that in thrombolysis treated patients (p=0.07). Causes for revascularisation delay greater than 60 minutes from presentation are discussed.
Conclusions: With appropriate facilities and organisation, patients with acute myocardial infarction presenting within normal working hours can be treated with primary PTCA without compromising their care due to time delay. Many patients managed with primary revascularisation by thrombolysis or primary PTCA with a delay of more than 60 minutes have identifiable clinically appropriate delays.     

补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞

目的探讨补救性经皮冠状动脉腔内成形术（ＰＴＣＡ）在治疗急性心肌梗塞（ＡＭＩ）中的作用。方法对溶栓治疗失败的３６例患者进行补救性ＰＴＣＡ治疗。患者心功能Ｋｉｌｐ分级：Ⅲ级和Ⅳ级４例，Ⅱ级和Ⅰ级３２例。冠状动脉造影显示梗塞相关动脉：前降支１７例，右冠状动脉１４例，回旋支４例，中间动脉１例。ＰＴＣＡ前ＴＩＭＩⅠ级和Ⅰ～Ⅱ级血流各２例，余３２例均为ＴＩＭＩ０级。３６例均进行ＰＴＣＡ治疗，其中１３例患者置入了支架。结果术中除３例失败外，３１例患者病变血管血流达到ＴＩＭＩⅢ级，２例ＴＩＭＩⅡⅢ级，残余狭窄≤５０％，成功率为９１．７％。院内并发症：１例在ＰＴＣＡ成功后当天因顽固性休克和心室纤颤死亡；１例于第３天死于心脏破裂，住院病死率为５．６％。１４例患者在术后１～２个月内复查冠状动脉造影，２例发生再狭窄。结论ＡＭＩ患者在溶栓治疗失败后，在有条件的医院可施行补救性ＰＴＣＡ治疗，成功率高，对改善患者的近期和远期预后可能有利     

溶栓及PTCA治疗急性心肌梗塞92例临床分析

本文总结１９９１年８月至１９９６年４月应用溶栓及ＰＴＣＡ治疗ＡＭＩ９２例，男７６例，女１６例，年龄４６～７０岁之间，平均年龄６０．２±１０．５岁。治疗分为：①冠状动脉内输注尿激酶（ＩＣＵＫ）组３２例；②静脉输注尿激酶（ＩＶＵＫ）组４１例；③经皮冠状动脉腔内成形（ＰＴＣＡ）组１９例。全组再通６９例，总再通率为７５．０％，ＩＣＵＫ组、ＩＶＵＫ组、ＰＴＣＡ组再通率分别为７５．０％、６５．７％和９４．７％三组再通率比较有显著差异。三组患者近期预后比较：全组９２例，死亡９例，死亡率９．７８％，８例发生于梗塞血管未通者，１例发生于血管再通者。ＩＣＵＫ组３２例，死亡３例（９．３７％），发生心功能不全８例（２５．０％）；ＩＶＵＫ组４１例，死亡５例（１２．０％），发生心功能不全１１例（２６．８３％）；ＰＴＣＡ组１９例，死亡１例，死亡率为５．２６％，ＰＴＣＡ组无心功能不全者。     

急性心肌梗塞急诊PTCA后ST段改变及其临床意义

目的　对９５ 例急性心肌梗塞（ＡＭＩ）患者急诊经皮冠状动脉腔内成形术（ＰＴＣＡ）后３０ 分钟体表心电图ＳＴ 段改变进行分析，探讨此时ＳＴ 段改变与ＰＴＣＡ 效果、心肌损害程度及心功能预后的关系。方法　根据ＳＴ 段改变分三组。组Ⅰ：ＳＴ 段明显下降（≥５０％ ）组５５ 例，组Ⅱ：ＳＴ 段下降（＜ ５０％ ）组３２ 例，组Ⅲ：ＳＴ 段无变化或抬高者组８ 例。测定术后肌酸激酶（ＣＫ）的变化，同时测定术前及术后心功能。结果　组Ⅰ与组Ⅱ为ＰＴＣＡ 成功者，术后组ⅡＣＫ 明显高于组Ⅰ。术后４～６ 周组Ⅱ射血分数（ＥＦ％ ）明显低于组Ⅰ。结论　急性心肌梗塞患者ＰＴＣＡ 术后３０ 分钟体表心电图ＳＴ 段的改变能间接反映ＰＴ－ＣＡ 疗效。较准确早期了解心肌细胞灌注情况并判定预后     

急诊冠脉介入治疗急性心肌梗塞的临床观察

目的：观察急诊冠脉介入治疗急性心肌梗塞（AMI）的安全性及有效性。方法：对42例AMI患者在发病0．5～12小时内行直接PTCA术，必要时联合临时心脏起搏技术及主动脉气囊反搏术，梗死相关血管（IRA）43支，TIMI血流0级：30例（71．4％），Ⅰ级：9例（21．4％），Ⅱ级：3例（7．2％）。结果：43支IRA中39支获得再通（90．9％），均达TIMI Ⅲ级血流，再通血管残余狭窄〈20％，5例合并左心功能不全（killip分级Ⅱ～Ⅲ级）及3例合并心源性休克患者，术后症状明显改善，1例死亡（2．5％）。术后6例（15％）直接PTCA成功患者心绞痛再发，再次PTCA后血管再通。结论：直接PTCA治疗AMI成功率高，病死率低，近期预后良好，是一种安全有效的治疗方法。     

Total absence of ST-segment resolution after failed thrombolysis is correlated with unfavorable short- and long-term outcomes despite successful rescue angioplasty

Introduction

ST-segment resolution (STR) is a well-established and simple tool for assessing the efficacy of reperfusion therapy in myocardial infarction. An incomplete (<50%) STR is a recognized marker of failed thrombolysis and a suitable recruitment criterion for rescue angioplasty.

Objective

We sought to determine the predictive value of the total absence of STR after thrombolysis in rescue angioplasty (percutaneous coronary intervention [PCI]).

Methods

Eighty-one consecutive patients who underwent a rescue angioplasty for failed thrombolysis in our institution from 2001 to 2007 were included. Two groups of patients were defined according to their STR extent, 90 minutes after lysis: partial resolution group 1 (10%-50% STR) vs absence of resolution group 2 (<10% STR) and compared in terms of in-hospital and long-term outcomes.

Results

Patients of group 2 were more likely to experience hemodynamic deterioration (50% vs 24%; odds ratio [OR] = 3.17; P = .017), to have a Thrombolysis in Myocardial Infarction 0 flow on the culprit artery (62.3% vs 42%; OR = 2.24; P = .045), to have a multivessel disease (66.7% vs 40%; OR = 3; P = .018), and to die during index hospitalization (26.7% vs 6%; OR = 5.69; P = .013) despite statistically similar rates of PCI failure in both groups (10% vs 7%; P = .402) and similar post-PCI STR (72% ± 18.25% vs 75% ± 11.62%; P = .36). In multivariate analysis, total absence of STR proved to be an independent predictor of in-hospital mortality (HR = 7.02; P = .032; 95% confidence interval, 1.18-41.58). Long-term major adverse cardiac events occurred more frequently in group 2 (log rank, P = .004) and were (on the Cox regression model) independently predicted by total absence of STR (HR = 6.21; P = .023; 95% confidence interval, 1.28-29.1).

Conclusions

The STR assessment before rescue PCI proved to be a good and simple means to predict the short- and long-term prognosis in these patients.     

Primary angioplasty reduces risk of myocardial rupture compared to thrombolysis for acute myocardial infarction

Although the mechanical complications of acute ventricular septal defect and acute mitral regurgitation are uncommon after acute myocardial infarction, these complications are associated with an extremely high morbidity and mortality. We hypothesized that the administration of thrombolytic drugs may result in hemorrhagic infarction as well as the potential for incomplete revascularization and thus may lead to an increased incidence of mechanical complications compared to primary angioplasty. Accordingly, we reviewed the data of the most contemporary thrombolytic and primary angioplasty trials and compared the incidence of mechanical complications among 36,303 patients treated with thrombolytics reported in the GUSTO trial to the incidence of mechanical complications among 1,295 patients treated with primary angioplasty obtained from the PAMI-1 and PAMI-2 trials. We found that angioplasty resulted in an overall 86% relative risk reduction in mechanical complications (2.20% vs. 0.31%, P < 0.001). In comparison to thrombolytic therapy, angioplasty resulted in an 82% decrease in acute mitral regurgitation (1.73% vs. 0.31%, P < 0.001) and a 100% decrease in acute ventricular septal defect (0.47% vs. 0.00%, P < 0.03). In conclusion, in patients with acute myocardial infarction, reperfusion with primary angioplasty is associated with less myocardial rupture and mechanical complications than thrombolytics. This finding may, in part, explain the improved prognosis observed in myocardial infarction patients treated with primary angioplasty. Cathet. Cardiovasc. Diagn. 42:151–157, 1997. © 1997 Wiley-Liss, Inc.