Primary coronary angioplasty for acute myocardial infarction with contraindication to thrombolysis.
Primary coronary angioplasty for acute myocardial infarction with contraindication to thrombolysis.
复制标题
初次冠状动脉成形术治疗有溶栓禁忌症的急性心肌梗塞。
DOI：
10.1016/0002-9149(93)90435-f
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发表时间：
1993
影响因子：
2.8
通讯作者：
R. Gourgon
中科院分区：
文献类型：
--
作者：
D. Himbert;J. Juliard;P. Steg;G. Badaoui;S. Baleynaud;D. Le Guludec;M. Aumont;R. Gourgon
急性心肌梗死（AMI）患者如果不能接受溶栓治疗，常规药物治疗的病死率和致残率都很高。在226例Q波AMI发作6小时内住院的连续患者中，45例（20%）有溶栓禁忌症。所有患者均接受急诊血管成形术治疗。45例患者的平均年龄为60 ± 11岁，8例（18%）≥70岁; 17例（38%）患有多支血管疾病，5例（11%）出现心源性休克。45例患者中有42例（93%）在入院后52 ± 27分钟和疼痛发作后238 ± 100分钟成功进行血管成形术。总体住院死亡率为9%（4/45）。未发生大出血或卒中。有1例早期症状性再闭塞，经紧急重复血管成形术治疗，无再梗死。33例患者的出院前血管造影仅显示1例无症状再闭塞（3%）。出院时射血分数为46 ± 13%。19例患者在6个月时重复导管插入术显示4例再狭窄（21%）和4例再闭塞（21%）的梗死相关动脉。有3例晚期死亡（2例非心源性），1年和3年生存率分别为87%和85%，无事件生存率分别为71%和69%（包括院内死亡）。无晚期再梗死病例。因此，在该系列中，直接冠状动脉成形术被证明是安全的，并且在AMI期间快速恢复持续的梗死血管通畅方面非常有效，并且导致早期和晚期结局的改善比文献中报道的在这个禁忌溶栓治疗的高危亚组中接受药物治疗的受试者更大。
Patients with acute myocardial infarction (AMI) and contraindication to thrombolysis have a high mortality and morbidity with conventional medical treatment. Among 226 consecutive patients hospitalized within 6 hours of the onset of Q-wave AMI, 45 (20%) had contraindications to thrombolysis. All were treated by emergent primary angioplasty. Mean age of the 45 patients was 60 ± 11 years and 8 (18%) were ≥70 years old; 17 (38%) had multivessel disease and 5 (11%) presented with cardiogenic shock. Successful angioplasty was achieved in 42 of the 45 patients (93%) 52 ± 27 minutes after admission and 238 ± 100 minutes after the onset of pain. Overall in-hospital mortality was 9% (4 of 45). Neither major bleeding nor stroke occurred. There was 1 case of early symptomatic reocclusion, treated with emergent repeat angioplasty without reinfarction. Predischarge angiography in 33 patients showed only 1 silent reocclusion (3%). Ejection fraction at discharge was 46 ± 13%. Repeat catheterization at 6 months in 19 patients showed 4 restenoses (21%) and 4 reocclusions (21%) of the infarct-related artery. There were 3 late deaths (2 noncardiac), which gave survival rates of 87 and 85% at 1 and 3 years, respectively, and event-free survival rates of 71 and 69% including in-hospital deaths. There were no cases of late reinfarction. Consequently, in this series, primary coronary angioplasty proved safe and highly effective in rapidly restoring sustained infarct-vessel patency during AMI, and led to a greater improvement in early and late outcomes than that reported in the literature for medically treated subjects in this high-risk subset for which thrombolytic therapy is contraindicated.