Coronary recanalization in acute myocardial infarction: immediate results and potential risks.
Coronary recanalization in acute myocardial infarction: immediate results and potential risks.
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急性心肌梗死的冠状动脉再通：即时结果和潜在风险。
DOI：
10.1093/oxfordjournals.eurheartj.a061326
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发表时间：
1982
影响因子：
39.3
通讯作者：
P. Hugenholtz
中科院分区：
文献类型：
--
作者：
P. Serruys;M. J. Van den brand;T. Hooghoudt;M. Simoons;P. Fioretti;J. Ruiter;P. W. Fels;P. Hugenholtz
1980 年 9 月至 1982 年 3 月期间，83 名患者在心肌梗塞急性期接受了导管插入术，目的是疏通梗塞相关血管 (IRV)；在这 83 人中，有 30 人参加了一项随机研究。五名患者在导管插入过程中死亡，其中两名患者死于心源性休克，两名患者死于血栓物质迁移，一名患者在成功再通后可能发生心脏破裂。在 15 名患者中，在第一次冠状动脉注射时发现 IR V 是明显的。其余 64 名 IRV 闭塞患者中，41 条动脉成功再通。
在尝试再通的幸存患者中，29 名出现需要治疗的非致命并发症（心室颤动、室性心动过速或室性早搏、心动过缓、低血压、房室传导阻滞、心房颤动）。并发症主要发生在血管造影完成再通后的低血压患者中。在 41 例成功的再通中，有 20 例发生并发症。在所有再通的右冠状动脉中，81% 发生并发症，左回旋动脉发生并发症 25%，左前降支发生并发症 24%。
总之，导管插入术和闭塞动脉再通的尝试会带来致命和非致命并发症的巨大风险。这些尤其发生在闭塞的右冠状动脉重新开放后的第一次血管造影期间。这些观察结果得出以下建议：
(1) 在循环得到充分支持之前不应考虑链激酶输注：
(2) 在尝试再通之前应预防性给予利多卡因和硝苯地平；
(3)血管造影应使用非离子型造影剂。
Between September 1980 and March 1982, 83 patients were catheterized during the acute phase of their myocardial infarction with the intention to recanalize their infarct-related vessel (IRV); of these 83, 30 participated in a randomized study. Five patients died during the catheterization procedure, two as a result of cardiogenic shock, two of migration of thrombotic material and one of possible heart rupture after a successful recanalization. In 15 patients the IR V was found to be patent at the first coronary injection. In the remaining 64 patients with an occluded IRV, 41 arteries were successfully recanalized.
Of the surviving patients who underwent an attempt at recanalization, 29 had non-fatal complications which required treatment (ventricular fibrillation, ventricular tachycardia or ventricular premature beats, bradycardia, hypotension, artrioventricular block, atrial fibrillation). The complications were predominantly observed in hypotensive patients during angiography after recanalization had been accomplished. Of the 41 successful recanalizations, complications occurred in 20. Of all recanalized right coronary arteries, complications took place in 81%, of the left circumflex arteries in 25% and of the left anterior descending arteries in 24%.
In conclusion, catheterization and attempts at recanalization of occluded arteries impose a substantial risk of fatal and non-fatal complications. These occur in particular during the first angiogram after the re-opening of an occluded right coronary artery. These observations lead to the following recommendations:
(1) streptokinase infusion should not be considered before the circulation is adequately supported:
(2) lidocaine and nifedipine should be administered prophylactically before the attempt at recanalization;
(3) a non-ionic contrast medium should be used for angiography.