急性心肌梗死溶栓治疗失败患者补救性血管成形术的短期结果
[Short-term results of rescue angioplasty in patients with acute myocardial infarction and failure of thrombolysis treatment].
作者信息
Palomo Villada José Antonio, Santiago Hernández Jaime Alfonso, González Díaz Belinda, Astudillo Sandoval Raúl, Flores Flores Jesús, Montoya Silvestre Armando, Estrada Gallegos Joel, Bernal Ruiz Enrique, Farell Campa Javier
机构信息
Médico del Servicio de Hemodinamia, Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social.
出版信息
Arch Cardiol Mex. 2005 Jul-Sep;75(3):296-305.
UNLABELLED
The present study is aimed at describing the short-term assessment of clinical and angiographic results in patients with acute myocardial infarction treated with rescue percutaneous transluminal coronary angioplasty (RPTCA).
METHODS
We reviewed retrospectively, from January 2001 to July 2004, the interventional procedures performed in patients with coronary heart disease. From a total of 3,258 patients we selected 32 (0.98%) with acute myocardial infarction and failure of thrombolysis treatment, which were treated with RPTCA to relief the symptoms. Average age was 63 years (range 47-79), there were 24 men (75%); hypertension in 29 (90.6%); diabetes mellitus in 18 (56.3%); currently smoking 24 (75%); dyslipidemia in 11 (34.4%); unstable angina in 9 (28.1%); previous myocardial infarction in 2 (6.3%). The area related to the infarction was anterior and lateral in 14 (43.8%), anteroseptal in 6 (18.8%), postero-inferior in 5 (15.6%) with electric and hemodynamic involvement in 4 (12.5%), lateral in 1 (3.1%). Thrombolysis treatment was delivered in 3.19 hours (range 2-7 hours) with streptokinase in 19 (59.4%) and rTPA in 13 (40.6%). The evaluated serum marker was CPK-MB with the highest level of 348 +/- 240 U/L. Killip Kimball (KK) class was established as follows: KKI in 5 (15.6%), II in 16 (50%), III in 5 (15.6%), and IV in 6 (18.8%). Patients with cardiogenic shock were treated with intra-aortic balloon counter-pulsation.
RESULTS
Time between symptoms and arrival to the cath lab was 11 hours (range 6-24 hours). TIMI flow was: TIMI 0 in 16 (50%). TIMI 1 in 10 (31.2%), TIMI 2 in 6 (18.8%). The number of vessels with a significant lesion was 1.9 (range 1-4). Stents were placed in 27 (84.3%) patients. Angiographic success postangioplasty was achieved in 24 (75%); there were 9 complications (28.1%), no reflow in 7 (21.8%), coronary dissection in 1 (3.1%). Six patients died (18.7%) and 4 of them (12.5%) were in cardiogenic shock.
CONCLUSION
RPT-CA is a high-risk procedure, being an acceptable treatment option for patients with thrombolysis failure.
未标注
本研究旨在描述接受补救性经皮冠状动脉腔内血管成形术（RPTCA）治疗的急性心肌梗死患者的临床和血管造影结果的短期评估。
方法
我们回顾性分析了2001年1月至2004年7月间对冠心病患者进行的介入治疗。在总共3258例患者中，我们选择了32例（0.98%）急性心肌梗死且溶栓治疗失败的患者，对其进行RPTCA以缓解症状。平均年龄为63岁（范围47 - 79岁），男性24例（75%）；高血压29例（90.6%）；糖尿病18例（56.3%）；目前吸烟者24例（75%）；血脂异常11例（34.4%）；不稳定型心绞痛9例（28.1%）；既往心肌梗死2例（6.3%）。梗死相关区域为前壁和侧壁14例（43.8%），前间隔6例（18.8%），下后壁5例（15.6%），伴有电活动和血流动力学改变4例（12.5%），侧壁1例（3.1%）。溶栓治疗在3.19小时（范围2 - 7小时）进行，其中19例（59.4%）使用链激酶，13例（40.6%）使用rTPA。评估的血清标志物为CPK - MB，最高水平为348±240 U/L。Killip Kimball（KK）分级如下：I级5例（15.6%），II级16例（50%），III级5例（15.6%），IV级6例（18.8%）。心源性休克患者接受主动脉内球囊反搏治疗。
结果
症状出现至到达导管室的时间为11小时（范围6 - 24小时）。TIMI血流分级为：TIMI 0级16例（50%），TIMI 1级10例（31.2%），TIMI 2级6例（18.8%）。有明显病变的血管数量为1.9（范围1 - 4）。27例（84.3%）患者置入了支架。血管成形术后血管造影成功24例（75%）；有9例并发症（28.1%），无复流7例（21.8%），冠状动脉夹层1例（3.1%）。6例患者死亡（18.7%），其中4例（12.5%）死于心源性休克。
结论
RPT - CA是一种高风险手术，对于溶栓失败的患者是一种可接受的治疗选择。
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