急性心肌梗死患者急诊介入治疗时冠脉造影特点分析

目的探讨急性心肌梗死（AMI）患者急诊介入治疗（PCI）时冠状动脉造影特点。方法将入选的72例患者分为溶栓组41例和未溶栓组31例，比较分析两组患者冠脉造影结果。结果（1）急诊PCI的患者近2／3存在2支以上血管病变；（2）溶栓再通率虽然较自发再通率高，差异显著（29．3％vs67．8％，P〈0．01），但绝大多数仍为全闭塞或存在严重狭窄（占94．4％），且血流达到3级的较少，因而都需要支架治疗；（3）左冠闭塞部位好发于血管分叉处，即第一对角支开口处，右冠后分叉是右冠闭塞部位好发部位；（4）大多数IRA病变不长，平均只有（16±4．58）mm，单个支架可以解决问题，病变长度超过25mm的只有6例，需要两个支架连接；（5）IRA病变处出现钙化较非IRA出现钙化少（6．9％vs20．8％，P〈0．01），提示钙化对斑块破裂可能有一定保护作用；（6）支架术后可出现一定比例的无复流现象，占12．5％，预示远期预后不良；（7）AMI患者冠脉造影可以正常。结论充分掌握急诊PCI时IRA的特点，有利于确保手术的成功与术后疗效。

Analysis of the angiographic characteristics of percuteneous coronary intervention in acute myocardial infarction patients in emergency

Objective To investigate the angiographic characteristics of acute percuteneous coronary intervention （PCI） for acute myocardial infarction （AMI） in past 4 years in our hospital. Methods 72 angiograpbic data of acute patients underwent PCI were divided into groups with thromblysis of 41 and groups without thromblysis of 31. The angiographic characteristics of them were compared and analyzed. Results （ 1 ） Nearly 2/3 patients had coronary stenosis in more than two arteries. （2）The rate for achieving reperfusion in thromblysis group was higher than that in no - thromblysis group （29.3 % vs 67.8% ,P 〈0.01 ）. The majority of IRA suffered total occlusion or severe stenosis （94.4%）. Rare of them had TIMI 3 flow, so they needed to implant stent. （3）The occlusion of the left coronary artery usually located at the bifurcation of the first diagonal. （4）The most lesion of IRA was limited,mean length 16 ±4.58mm,only one stent was needed. 6 patients had diffuse lesion, need two continuous stents. （5） IRA usually without calcification （6.9% vs 20.8% ,P 〈 0.01 ）, implying calcification can protect the atheroma. （6）Noreflow occurred during procedure in 12.5%. （7） Some acute myocardial infarction occurred without coronary stenosis. Conclusion The understanding of ihe characteristics of the acute PCI will be helpful for a successful procedure.