直接支架植入在急性心肌梗死急诊PCI中的临床应用

摘要

Objective To evaluate the efficacy and safety of direct stenting technique in emergent percutaneous coronary intervention(PCI)for pa⁃tients with acute myocardial infarction(AMI). Methods Totally 460 consecutive patients with acute myocardial infarction who underwent emergent PCI during August 2010 to July 2013 were involved,among whom 346 patients were assigned to the control group(traditional balloon dilation and stenting),114 patients were assigned to the experiment group(direct stenting). The safety and efficacy of direct stenting technique was observed. Results In the control group,7 cases had no reflow during operation,2 cases had reflow after the pre⁃expansion and 5 cases after stent implanta⁃tion,no similar cases in the experiment group(P=0.125 9). The follow⁃ups showed the control group had 2 cases of major adverse cardiac events including 1 case of acute stent thrombosis who required urgent revascularization,and 1 case of cardiac death at four days after operation;the experi⁃ment group had 1 case of stent thrombosis,there was no statistically significant difference(P=0.730 7). Conclusion Direct stenting technique may be performed selectively for certain coronary diseases when performing emergent PCI for AMI.%目的：探讨直接支架植入在急诊经皮冠状动脉介入治疗（PCI）中应用的有效性和安全性。方法选取2010年8月至2013年7月于我院急诊行冠脉支架植入的患者460例，其中，行球囊扩张后支架植入的患者346例为对照组，直接冠脉支架植入的患者114例为观察组。观察直接支架植入的安全性和有效性。结果对照组中，7例术中无复流，2例发生在预扩张后，5例发生在植入支架后，观察组无类似病例，2组比较差异无统计学意义（P=0.1259）。对照组有2例主要心脏不良事件，1例发生急性支架内血栓形成行紧急血运重建，1例术后4d内心源性死亡；观察组有1例支架内血栓形成，2组比较差异无统计学意义（P=0.7307）。结论在急性心肌梗死行急诊PCI时，对某些有选择的冠脉血管病变行直接支架植入安全有效。