溶栓禁忌证的老年急性心肌梗死患者直接介入治疗的探讨

目的　探讨不能溶栓的老年急性心肌梗死 (AMI)患者直接介入治疗的安全性与有效性。方法　对 31例 70岁以上的患者 ,3例 6 0～ 6 9岁有溶栓禁忌证的老年心肌梗死的患者进行了直接经皮冠状动脉腔内成形术 (PTCA)与冠状动脉内支架术。结果　有 34例梗死相关动脉 (IRA)心肌梗死溶栓试验 (TIMI)血流 0级 2 7例 ,1级 7例。 31例直接行PTCA成功 ,其中 4例患者直接PTCA后其残余狭窄 <10 %且无明显的内膜撕裂和夹层。 2 7例IRA具有支架置入的适应证 ,即刻造影IRATIMI血流达 3级。 2例行冠状动脉旁路移植术 (CABG)。有 1例因IRA完全闭塞 ,PT CA未能成功。直接介入成功率 97%。 31例患者经过平均 (11.4± 3.7)个月随访 ,无再梗死及急诊再次血运重建 ,但 4例有心绞痛 ,造影证实为冠状动脉支架再狭窄再次行PTCA成功。结论　对溶栓有禁忌证的老年AMI患者行直接介入治疗 ,具有较高的成功率及安全性。

Direct coronary intervention in old patients with acute myocardial infarction and contraindications for thrombolytic therapy

Objective To assess the safety and efficacy of direct percutaneous coronary intervention(PCI) in old patients with acute myocardial infarction (AMI),who could not be treated with thrombolytic therapy.Methods Direct percutaneous coronary intervention was performed in 31 patients aged over 70 years and 3 patients aged ranging from 60 to 70 years who had contraindications for thrombolytic therapy.The TIMI blood flow grade 0 was found in 27 cases and TIMI blood flow grade 1 in 7 cases.The infarction-related artery(IRA) was left anterior descending branch (LAD) in 18 cases,right coronary artery (RCA) in 10 and left circumflex artery in 6.Results Thirty-one IRA were opened and TIMI blood flow reached grade 3.The success rate of emergency intervention treatment reached 97%.Stents were implanted into 27 IRA,while 4 IRA only underwent percutaneous transluminal coronary angioplasty(PTCA) with residual stenosis less than 10%.One IRA was not opened because the guide wire could not pass the occluded calcified lesion.Two cases received coronary artery bypass graft operations,for 1 case had infarction-related RCA and lesion in LAD and the other case had long diffuse lesion in LAD.During average 11.4±3.7 month follow-up in 31 patients,no symptom appeared in 29 cases and angina symptom occurred in 2 cases who successfully underwent PTCA.Conclusions The direct coronary intervention treatment is safe and effective in patients with AMI who have contraindications for thrombolysis.