直接经皮冠脉成形术治疗急性心肌梗死的住院死亡原因分析

目的分析直接经皮冠脉成形术（PCI）治疗急性心肌梗死（AMI）住院期间的死亡原因.方法按入选标准对连续入院的235例AMI患者行直接PCI,记录住院期间死亡率、死亡原因及相关因素.结果15例患者住院期间死亡,住院总病死率为6.4%,心脏性死亡率为6.0%.直接死亡原因包括心脏破裂5例（33.3%）,心室纤颤5例（33.3%）,泵衰竭4例（26.7%）,脑卒中死亡1例（6.7%）.心脏破裂患者中继发于再次心肌梗死者1例.所有心室纤颤患者均为继发性,继发于再次心肌梗死的心室纤颤2例,继发于不稳定性心绞痛2例,继发于左室衰竭1例;1例为迟发性心室纤颤（PCI后2周）.泵衰竭患者中,心源性休克3例,左室衰竭1例.结论直接PCI治疗AMI患者住院期间死亡率为6.4%,心脏破裂、心室纤颤和泵衰竭是主要的死亡原因,术后严重心肌缺血和心力衰竭是重要诱因.

Causes of death of acute myocardial infarction patients who underwent primary percutaneous coronary intervention during hospitalization

Objective To analyse the causes of death in AMI patients who underwent primary percutaneous coronary intervention(PCI)during hospitalization.Methods Two hundred and thirty-five consecutive AMI patients underwent primary PCI. The mortality, the causes of death and correlative clinical characteristics during hospitalization were recorded. Results Fifteen patients died during stay hospital and total mortality was 6.4 % with cardiac mortality 6.0%.The primary causes of death included cardiac rupture(33.3%), ventricular fibrillation(33.3%), pump failure(26.7%) and stroke(6.7%). One case of cardiac rupture and 2 of ventricular fibrillation were secondary to reinfarction, another 2 were secondary to unstable angina including one secondary to left ventricular failure and the other of late ventricular fibrillation. The patients with pump failure included three cases of cardiac shock and one of left ventricular failure. Conclusion The total mortality was 6.4 % in patients who underwent primary PCI during hospitalization. Cardiac rupture, ventricular fibrillation and pump failure are the primary causes of death. Severe myocardial ischemia and heart failure are important inducing factors.