心肌梗死455例PCI后临床疗效观察

目的:观察评价不同时期心肌梗死(MI)患者经皮冠状动脉介入治疗(PCI)后即刻疗效及远期疗效. 方法:对1988-04/2001-12住西京医院的455例经PTCA(经皮冠状动脉腔内成形术)或(和)支架术并在术前已明确诊断的MI患者进行1 mo～8 a的随访. 其中69例为急性MI(AMI)后直接PCI或溶栓后补救性PCI;263例为AMI后2 mo内择期PCI和123例陈旧性MI(OMI,MI时间大于2 mo)后的PCI. 结果:在66例单纯球囊扩张术及389例结合支架术或直接支架术中,手术成功率98.5%,2例术中死亡,3例行冠状动脉旁路移植术. 382例随访1 mo,无症状存活率87.7%,死亡12例. 129例随访2～8 a,无症状存活52.7%,死亡10例. 71例有症状复查冠脉造影中,30例发生再狭窄. 结论:MI患者PCI即刻疗效好,远期无事件存活率52.7%,AMI伴多支病变或心源性休克是术后早期死亡的主要原因. 大于2 mo以上的MI患者也能在PCI中获益.

Observation of clinical effectiveness in 455 myocardial infarction patients treated with percutaneous coronary intervention

AIM: To evaluate the immediate and long term curing effectiveness in different stage myocardial infarction patients treated with percutaneous coronary intervention (PCI). METHODS: 1 month to 8 year follow up visits were performed in 455 myocardial infarction patients whose confirmed diagnosis had been before percutanous intervention and who had treated with emergency or selected PCI from April 1988 to December 2001 in Xijing Hospital. Of the 455 patients, 69 had had primary PCI or rescue PCI, 263 had had selected percutanous procedures within 2 months after acute myocardial infarction and 123 had PCI two months after myocardial infarction. RESULTS: The success rate of the procedures was 98.5% in the 455 cases, of whom 66 cases had only percutaneous balloon angioplasty and 389 cases had percutaneous balloon angioplasty plus stenting implanted or direct stenting. Two cases died in the procedures and 3 cases underwent bypass surgery. 382 patients were followed up for 1 m, of whom the rate of event free survival was 87.7% and 12 cases died. 129 patients were followed up for 2-8 years, of whom the rate of event free survival was 52.7% and 10 cases died. The re angiography was performed in 71 cases who had recurrence of angina pectoris and restenosis was found in 30 cases. CONCLUSION: PCI achieves satisfactory immediate result in myocardial infarction patients and the long term rate of event free survival is 52.7%. The main factors of mortality at early stage are acute myocardial infarction accompanied with triper vessel disease or cardiac shock. PCI also has fairly good result in patients with acute myocardial infarction for over 2 months.