1病情简介患者男,70岁,因“发作性胸痛14h,胸闷9h”由急诊以“急性广泛前壁心肌梗死”于2012年4月12日9am入院。入院后给予抗凝(低分子肝素5000U q12 h皮下注射7d),抗血小板聚集(阿斯匹林100 mg qn、氯吡格雷75 mg qd),调脂稳定斑块(阿托伐他汀10 mg qn),延缓心室重构(培哚普利2mg qd),扩冠(消心痛、单硝酸异山梨酯)、营养心肌等治疗。并密切观察患者血压、心功能、心电图演变、心肌酶及肝肾功情况。经治疗11d,4月23日复查肌酸肌酶、AST、血常规、凝血四项均正常,患者病情稳定。于2012年4月24日8:30am在局麻下行冠脉造影+支架置入术,先行左冠脉造影,发现前降支中段有近97%的狭窄;回旋支中段可见约75%狭窄;右冠脉造影未发现明显狭窄,但有弥漫性斑块。在确定罪犯血管为前降支后,用球囊预扩张一次,随后置入支架两枚(雷帕霉素药物涂层支架),重复造影,前降支血流 1 Synopsis The patient male, age 70, was admitted to hospital for 9am on April 12, 2012 due to “episodic chest pain 14h, chest tightness 9h” from the emergency department to “acute extensive anterior myocardial infarction.” After admission, patients were given anticoagulation (low molecular weight heparin 5000U q12h subcutaneously for 7 days), antiplatelet aggregation (aspirin 100 mg qn, clopidogrel 75 mg qd), lipid-stabilizing plaque (atorvastatin 10 mg qn ), Delayed ventricular remodeling (perindopril 2mg qd), crown expansion (heartburn, isosorbide mononitrate), and other treatment of myocardial nutrition. And closely observe the patient’s blood pressure, cardiac function, ECG evolution, myocardial enzymes and liver and kidney function situation. After treatment 11d, April 23 review of creatine kinase, AST, blood, coagulation, four were normal, the patient was stable. On April 24, 2012, at 8:30 am, coronary angiography + stent implantation was performed at local anesthesia. The left anterior coronary angiography was performed first and the proximal segment of the left anterior descending artery was found to be nearly 97% stenosis. The medial aspect of the circumflex artery was about 75% stenosis. Right coronary angiography showed no obvious stenosis, but diffuse plaques. In determining the culprit vascular descending anterior descending balloon pre-dilatation, followed by placement of two stents (rapamycin-coated stent), repeat angiography, anterior descending blood flow