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目的 :观察急诊直接经皮冠状动脉介入治疗 (PCI)、补救性PCI和延迟PCI 3种不同的经皮冠状动脉 (冠脉 )血运重建术治疗急性心肌梗死 (AMI)的疗效及并发症。方法 :因AMI住院并接受PCI治疗者 5 8例。急诊直接PCI者 19例 ,溶栓后梗死相关血管未通行补救性PCI者 12例 ,溶栓后梗死相关血管开通行延迟PCI 2 7例。直接PCI或补救性PCI者仅处理梗死相关血管 ,延迟PCI者除处理梗死相关血管外 ,对严重狭窄的非梗死相关血管也同时进行了处理。术后随访 3～ 2 4个月 ,观察心血管事件的发生情况。结果 :直接PCI和补救性PCI组梗死相关血管均成功开通 ,延迟PCI组除梗死相关血管外 ,对 17支非梗死相关血管进行了扩张或支架术 ,结果均获得成功血运重建。术中冠脉内血栓的发生率直接PCI和补救性PCI者较高 ,梗死相关血管重建术后即刻慢复流的发生率直接PCI和补救性PCI组也较延迟PCI组高 (P <0 .0 5 )。其中 2 0 %梗死相关血管和 2 9.4 %非梗死相关血管行直接支架置入 ,均获得有效的血运重建。梗死相关血管支架的置入率为 96 .7%。扩张后即刻造影结果平均残余狭窄为 (8± 6 ) % ,未发生与手术相关的严重并发症 ,手术成功率为 10 0 %。术后随访期间 3例死亡 ,2例术后 3个月内发生心绞痛 ,经造影证实再狭窄。结论 :经皮冠脉血运?
Objective: To observe the curative effect and complications of acute percutaneous coronary intervention (PCI), salvage PCI and delayed PCI in three kinds of acute percutaneous coronary intervention (AMI). Methods: Fifty-eight patients were hospitalized with AMI and received PCI. There were 19 cases of emergency PCI, 12 cases of infarction-related vascular failure after PCI, 12 cases of delayed PCI after thrombolysis. Direct PCI or rescue PCI only deal with infarct-related blood vessels, delayed PCI in addition to dealing with infarct-related blood vessels, the severely stenosed non-infarct-related blood vessels were also treated. The patients were followed up for 3 ~ 24 months and observed the occurrence of cardiovascular events. RESULTS: Infarct-related vessels were successfully opened in both PCI and rescue PCI groups. In addition to infarction-related extravasation, 17 non-infarcted vessels were dilated or stents were performed in the PCI group. All of them achieved successful revascularization. The incidence of intra-coronary thrombosis was higher in direct PCI and rescue PCI, and the incidence of immediate slow-flow after immediate post-infarction-related revascularization was also significantly higher in the direct PCI group and the rescue PCI group than in the delayed PCI group (P <0. 0 5). 20% of infarct-related blood vessels and 2 9.4% of non-infarct-related blood vessels were treated with direct stent implantation, all of which achieved effective revascularization. Infarction-related stent placement rate of 96.7%. Immediately after dilation, the average residual stenosis was (8 ± 6)%. No serious complications related to the operation occurred. The successful rate of operation was 100%. During the follow-up period, 3 patients died and 2 patients developed angina pectoris within 3 months after operation. Restenosis was confirmed by radiography. Conclusion: Percutaneous coronary blood flow?