Danchin N, Juillière Y
Service de cardiologie A, CHU Nancy-Brabois, Vandoeuvre-lès-Nancy.
Arch Mal Coeur Vaiss. 1992 Nov;85(11 Suppl):1651-4.
There is little data available on the precise indications of coronary angiography and myocardial revascularisation during the first week after myocardial infarction. Mechanical complications (subacute rupture, ventricular septal defect, ruptured mitral chordae), usually require emergency surgery: when the patient's haemodynamic status permits, preoperative coronary angiography is desirable. Recurrent ischaemia may be treated by urgent coronary angiography--dilatation; nevertheless, the results of this type of procedure are associated with high mortality and morbidity and it would seem better practice to start with repeat intravenous thrombolytic therapy: coronary angiography can then be performed in a less acute situation with a view to angioplasty. Finally, in most cases of uncomplicated infarctions, functional investigations such as exercise stress testing coupled with radioisotopic methods, may be usefully performed before coronary angiography to demonstrate any residual ischaemia justifying a myocardial revascularisation procedure: under these conditions, it seems more realistic to envisage coronary angiography 8 to 10 days after the initial coronary event.
关于心肌梗死后第一周内冠状动脉造影和心肌血运重建的确切指征，现有数据很少。机械性并发症（亚急性破裂、室间隔缺损、二尖瓣腱索断裂）通常需要急诊手术：当患者血流动力学状态允许时，术前进行冠状动脉造影是可取的。复发性缺血可通过紧急冠状动脉造影及扩张治疗；然而，这类手术的结果与高死亡率和高发病率相关，似乎更好的做法是先进行重复静脉溶栓治疗：然后在病情不太危急的情况下进行冠状动脉造影，以便进行血管成形术。最后，在大多数无并发症梗死的病例中，在冠状动脉造影前可进行运动负荷试验等功能检查并结合放射性同位素方法，以显示任何残留缺血，证明有必要进行心肌血运重建手术：在这些情况下，设想在初次冠状动脉事件发生后8至10天进行冠状动脉造影似乎更现实。
