PTCA+直接支架置入术治疗急性心肌梗死分析

目的：观察急性心肌梗塞（AMI）患者应用经皮冠状动脉腔内成形术（PTCA）＋直接支架置入术的安全性和有效性。方法：对22例AMI患者在发病12h内行PTCA术＋直接支架置入术，其中5例为心源性休克患者，梗塞相关血管共33支，前降支（LAD）12支，在回旋（LCX）7支，右冠状动脉（RCA）14支。术前心肌梗死相关动脉血流呈完全闭塞（TIMI0级或Ⅰ级）19例，不全堵塞（TIMIⅡ级Ⅲ级）3例；有明确新血栓者2例。结果：全部患者均成功进行PTCA并置入冠状动脉内支架，住院期间死亡1例（2．6％），为术后再狭窄行溶栓治疗时发生脑出血患者，1例发生术后再狭窄，再次PTCA＋支架置入术，2例合并糖尿病患者发生穿刺点出血，经相应处理后好转，结论：直接：PTCA＋支架置入手术是治疗急性心肌梗塞的安全有效措施，成功率较高，并发症少，术后复发心肌缺血发生率较溶栓治疗和单PTCA低。

Percutaneous transluminal coronary angioplasty and direct intracoronary stent experience in acute myocardial infarcion

Objective To evaluate the efficiency and safety of percutaneous transluminal coronary angioplasty and direct intracoronary stent in acute myocardial infarcion(AMI)patients.Methods Direct angioplasty and stent were performed in 22 patients within 12 hours from onset.Infarct related arteries(IRA)were left anterior descending artery in 12,left circumflex in 7,right coronary artery in 14.Thrombolysis in myocardial infarction(TIMI)0 and 1 flow was in 19,TIMI 2 and 3 was in 3.Five patients suffered from cardiac shock.Results Procedure success was all cases,and all of them were gained TIMI 3 flow.One patient died of cerebral haemorrhage,because of acute occlusion after acute re thrombolyses.One patient occurred recurrent ischemia and was revascularized.Two patients with diabetes occurred hemorrhage at the point of puncture.Conclusion Percutaneous transluminal coronary angioplasty and direct intracoronary stent is a safe and reliable therapeutic maneuver in AMI with high successful rate and low complication.The recurrent ischemia rate was lower than thrombolysis and PTCA.