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目的:观察急诊经皮腔内冠状动脉成形术(PTCA)及支架术治疗急性心肌梗塞(AMI)的安全性和有效性。方法:22例发病在3.8±3.1小时的 AMI 病人,5例为补救性 PTCA,17例直接 PTCA 术,置入冠脉内支架6枚。结果:22支梗塞相关血管(IRA)全部开通,前向血流均达 TIMIⅢ级,成功率100%,无手术并发症。其中2例合并心原性休克,2例 PTCA 术后无出现病理性 Q 波,1例补救性 PTCA 术成功,但术后第五天死于顽固性心衰,4例因多支病变再次行 PTCA。21例出院病人随访11～17个月无再发心绞痛或心肌梗塞,无室壁瘤形成。结论:急诊介入治疗 AMI 安全有效,并能改善病人近期和远期预后。
Objective: To observe the safety and efficacy of emergency percutaneous transluminal coronary angioplasty (PTCA) and stenting in the treatment of acute myocardial infarction (AMI). Methods: Twenty-two AMI patients with onset of 3.8 ± 3.1 hours, 5 patients with salvage PTCA and 17 patients with PTCA were treated with coronary stent. Results: Twenty-two infarct-related blood vessels (IRA) were completely opened. The antegrade blood flow reached TIMI grade III with a success rate of 100%. No complications were found. Two of them were complicated by cardiogenic shock. Two cases of PTCA showed no pathologic Q wave, one case of salvage PTCA was successful, but died of refractory heart failure on the fifth day after operation and four cases of multi-vessel disease again PTCA. 21 patients discharged from hospital were followed up for 11 to 17 months without recurrent angina or myocardial infarction, no aneurysm formation. Conclusions: Emergency interventional treatment of AMI is safe and effective, and can improve the short-term and long-term prognosis of patients.