左冠状动脉主干急性闭塞致心肌梗死急诊PCI预后分析

摘要

Objective:To evaluate clinical outcome of emergency percutaneous coronary intervention (PCI)for acute left main coronary artery (LMCA) occlusion in patients with myocardial infarction treated in a center without on-site cardiothoracic surgical backup. Methods: Among 251 consecutive patients with acute myocardial infarction who underwent emergency PCI, 11 patients had acute LMCA occlusion. In-hospital and follow-up clinical outcomes were measured after the procedure. Results:Of these 11 patients, 9 with cardiogenic shock received intra-aortic balloon pump(IABP) counterpulsation, and 2 patients with bradycardia required temporary cardiac pacemaker. Immediately after PCI, 4 patients developed no-reflow phenomenon. Overall, 3 patients died during hospitalization. No cardiac death or re-infarction occurred during follow-up. Conclusion: Emergency PCI is effective for improving outcomes in patients with myocardial infarction caused by acute LMCA occlusion in centres without on-site cardiothoracic surgical backup.%目的:评价左冠状动脉主干(LMCA)急性闭塞引起心肌梗死患者在无外科保护下行急诊经皮冠状动脉介入术(PCI)的临床疗效. 方法:从2002年1月至2008年12月,在529例急性心肌梗死患者中确诊LMCA急性闭塞11例,均接受急诊PCI,观察住院和随访期死亡率. 结果:在11例LMCA急性心肌梗死中,9例发生心源性休克患者置入主动脉内球囊反搏泵,2例心动过缓患者予以临时起搏器治疗.PCI后即刻,4例发生无复流现象.3例院内死亡.平均随访(31±25)个月,其余8例患者均无死亡和再梗死. 结论:无外科保护下对LMCA急性闭塞引起心肌梗死患者行急诊PCI能改善住院期和远期临床预后.