急性心肌梗塞溶栓失败患者行补救性经皮腔内冠状动脉成形术临床研究

为评价溶栓失败急性心肌梗塞（AMI）行补救性经皮腔内冠状动脉成形术（PTCA）的疗效及安全性，对35例AMI患者溶栓后90min行冠状动脉造影。根据梗塞相关动脉开通情况，16例成功者（甲组）中12例7～21d后行延迟PTCA治疗；19例失败者（乙组）中13例（乙1组）即刻行补救性PTCA，其余6例（乙2组）溶栓失败而未行PTCA者给一般药物治疗。结果表明，甲级中12例行延迟PTCA，成功11例（91．6％），正例于PTCA中出现冠状动脉急性闭塞并致小灶下壁心肌梗塞；乙1组13例行补救PTCA，全部成功（100％）。甲组住院期总心脏事件发生率（19％）与乙1组（23％）相似，且出院前心功能无显著差异。而乙2组6例中住院期死亡率（33％）及总心脏事件发生率（50％）增高。提示AMI溶栓失败患者补救PTCA成功率高、并发症少，能减少住院期心脏事件并促进左心室功能改善。

A clinical study of rescue PTCA after failed thrombolysis for patients with acute myocardial infarction

To assess the efficacy and safety of rescue PTCA after failed thrombolysis for pa tients with acute myocardial infarction (AMI),thirty-five patients with AMI were received coro nary angiography 90 min after initiation of thrombolytic therapy. Based upon angiographic infarct related artery patencyl 12 among 16 patients with successful thrombolysis (group A) underwent dalayed PTCA 7~21 days later and 13 patients failed after thrombolysis had rescue PTCA immediatly (group B1). The remaining 6 patients with failed thrombolysis but without rescue PTCA (group B2) were treated medically. The success rate and acute complications of PTCA in groups A and B and in-hospital total cardiac events (cardiac death,reinfarction,severe heart failure and criti cal arrhythmia) for all groups were recorded. Predischarge left ventricular function was assessed by two-dimensional echocardiogralhy. In group A 12 patients underwent delayed PTCA which was successful in 11 patients (91. 6% ) and one patient developed acute coronary closure and small infe rior infarction during PTCA. In group B1 13 patients received rescue PTCA which was successful in all patients (100%) Total cardiac events during hospitalizition were similar in group A (19%) and B1 (23%). There was no significant difference in predischarge left ventricular function between the two groups.However the in-hospital total cardiac events were higher in group B,(50%). Rescue PTCA after failed thrombolysis for patients with AMI is safe and has high success rate with less acute complications. It decreases in-hospital total cardiac events and improves left ventricular function.