急诊冠状动脉介入治疗急性心肌梗死的临床研究

目的通过回顾性分析,探讨急诊经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMl)的安全性和治疗效果.方法我院收治的ST段抬高的急性心肌梗死患者,发病时间在12h内,行急诊冠状动脉造影、急诊PCI和支架植入术.如果梗死相关血管(IRA)前向血流为TIMI 0～2级或虽达到TIMI 3级,但残余狭窄≥90%者采取急诊PCI治疗.结果入选急性心肌梗死患者119例行急诊冠状动脉造影,男82例,女37例,年龄35～86岁,平均(58.8±12.7)岁,冠状动脉造影显示:IRA为前降支72例;右冠状动脉为43例;回旋支为4例.110例患者IRA行球囊扩张和支架植入,有7例患者行球囊扩张后残余狭窄＜20%,TIMI 3级,未进一步行支架置入.行PCI的117例患者,成功率98.8%,IRA的前向血流达到TIMI 3级的达95.4%.随访30d,95例患者(80%)无事件生存,住院期间死亡5例,发生急性和亚急性闭塞5例.结论急性心肌梗死行紧急PCI,疗效明显且安全,应在有条件的医院大力开展,推广应用.

EMERGENT PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective To evaluate the safety and effectiveness of percutaneous coronary intervention in patients with acute myocardial infarction(AMI). Methods From May 2001 to Oct. 2003,119 patients with ST-elevation acute myocardial infarction within 12 hours from onset, were performed e-mergent angiography. Patients with infarct related-arteries blood flow TIMI 0-2 and stenosis more than 90% underwent PTCA and stenting. Results Of the patients, there were 82 males and 37 females, aged from 35 to 86 years old. Infarct related - arteries were LAD in 72,RCA in 43 and LCX in 4 patients. Procedure successful rate was 98.8% and 95.4% gained TIMI 3 blood flow. The coronary stent were implanted in 110 cases. With 30 days follow - up,95 patients(80%) were events free. 5 patients died,during hospitalization. 5 patients occurred acute and subacute thrombosis. Conclusion E-mergent percutaneous coronary intervention is a safe and effective therapy for AMI.