急性心肌梗塞直接经皮冠状动脉腔内成形术

目的观察急性心肌梗塞（ＡＭＩ）患者应用直接经皮冠状动脉腔内成形术（ＰＴＣＡ）的安全性和有效性。方法对１１４例ＡＭＩ患者在发病１２小时内行直接ＰＴＣＡ术，其中有５例心原性休克的患者。梗塞相关血管（共１１５支血管）：左主干３例（２．６％），前降支５６例（４８．７％），回旋支１２例（１０４％），右冠状动脉４４例（３８．５％）。ＴＩＭＩ血流：０级８２例（７１．３％），１级１７例（１４．７％），２级１６例（１４．０％）。结果１１１例患者手术成功，ＴＩＭＩ血流３级（９７．４％）。住院期间死亡３例（２．６％），均为心原性休克患者，其中２例经紧急冠状动脉旁路移植术后死亡。８５例患者置入了冠状动脉内支架（７３．９％）。随访９５例患者，２例后期死于心力衰竭，９例出院后出现心肌缺血，其中８例再次行ＰＴＣＡ术。结论直接ＰＴＣＡ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低。

Direct percutaneous transluminal coronary angioplasty experience in acute myocardial infarction

Objective To evaluate the efficiency and safety of direct angioplasty in acute myocardial infarction (AMI) patients. Methods Direct angioplasty was performed in 114 patients within 12 hours from onset. Single vessel disease was in 66 patients (57.9%), double vessel disease in 28 (24.6%) and triple vessel disease in 20 (17.6%). Infarct relatedarteries (IRA) were left main in 3 (2.6%), left anterior descending artery in 56(48.7%), left circumflex in 12 (10.4%), right coronary artery in 44 (38.5%). Thrombolysis in myocardial infarction (TIMI) 0 flow was in 82 (71.3%), TIMI 1 flow in 26 (22.7%), TIMI 2 flow in 16 (14.7%). Five patients suffered from cardiac shock and 6 patients were performed intraaortic balloon pump (IABP). Results Procedure success was 111 cases (successful rate 97.4%) and all of them were gained TIMI 3 flow. Three patients died of cardiac shock in hospital and 2 of them died during emergent CABG because of failure angioplasty procedure. The coronary stent were implanted in 85 patients (73.9%). With following up 95 patients, 2 patients died of congestive heart failure, 9 patients occurred recurrent ischemia and 8 of them were revascularized. Conclusion Direct angioplasty is a safe and reliable therapeutic maneuver in AMI with its high successful rate and low complication. The recurrent ischemia rate was lower than thrombolysis.