Mossard J M, Arbogast R, Roman S, Baruthio J, Germain P, Roul G, Kraenner C, Bareiss P, Sacrez A
Service de cardiologie, hôpital de Hautepierre, CHU de Strasbourg.
Arch Mal Coeur Vaiss. 1991 Apr;84(4):469-75.
One hundred patients admitted to a centre of interventional cardiology with acute myocardial infarction of less than 6 hours, underwent coronary angioplasty of first intention because of contra-indications to thrombolytic therapy (n = 20) or after thrombolytic therapy with streptokinase (n = 54), acylenzymes (n = 12) or tissue type plasminogen activator (n = 14). The indication of angioplasty were those of the TIMI (Thrombolysis in Myocardial Infarction) classification (occluded artery, TIMI grade 0) (n = 60) (suboccluded artery, TIMI grade 1) (n = 40). The criterion of success of angioplasty was an increase greater than 1 of TIMI grade. Reperfusion of the coronary artery was obtained by angioplasty in 95% of failures of thrombolysis and in 90% of patients with contra-indications to thrombolytic therapy. The early reocclusion rate at D1 was 2%. Repeat angioplasty at D1 was successful in both these cases and the arteries were still patent at D21. The reocclusion rate at the third week in 75 patients who underwent control coronary angiography was 5.3%. In patients with arterial occlusion, immediate angioplasty attained two objectives in the same procedure: a high rate of emergency myocardial reperfusion and a low rate of reocclusion. The average left ventricular ejection fraction (all arteries) significantly improved (+9.2% in absolute values) when the artery remained patent (p less than 0.001), especially when the initial ejection fraction was low. In the patients who had occluded arteries at control angiography at 3 weeks, the ejection fraction decreased (-4% in absolute values) (NS). The following complications were observed: 4 coronary artery dissections and haematomas at the site of femoral puncture in patients who had received thrombolytic therapy (10 drained surgically). The hospital mortality was 3% and global mortality after an average follow-up period of 19.6 months was 5%. Coronary angioplasty in acute myocardial infarction carries a low risk and seems to be beneficial in patients with contra-indications to or failure of thrombolysis.
100例因急性心肌梗死发病少于6小时而入住一家介入心脏病中心的患者，因存在溶栓治疗禁忌证（n = 20）或在接受链激酶（n = 54）、酰基酶（n = 12）或组织型纤溶酶原激活剂（n = 14）溶栓治疗后，接受了直接冠状动脉成形术。冠状动脉成形术的适应证为心肌梗死溶栓治疗（TIMI）分类标准（动脉闭塞，TIMI 0级）（n = 60）（次全闭塞动脉，TIMI 1级）（n = 40）。冠状动脉成形术成功的标准是TIMI分级提高超过1级。在95%的溶栓失败患者和90%有溶栓治疗禁忌证的患者中，通过冠状动脉成形术实现了冠状动脉再灌注。第1天的早期再闭塞率为2%。在这两例患者中，第1天重复冠状动脉成形术均成功，且动脉在第21天仍保持通畅。在75例行冠状动脉造影复查的患者中，第3周的再闭塞率为5.3%。在动脉闭塞患者中，即刻冠状动脉成形术在同一操作中实现了两个目标：较高的急诊心肌再灌注率和较低的再闭塞率。当动脉保持通畅时，平均左心室射血分数（所有动脉）显著改善（绝对值增加9.2%）（p < 0.001），尤其是初始射血分数较低时。在3周时冠状动脉造影显示动脉闭塞的患者中，射血分数下降（绝对值下降4%）（无显著性差异）。观察到以下并发症：接受溶栓治疗的患者中有4例冠状动脉夹层和股动脉穿刺部位血肿（10例手术引流）。住院死亡率为3%，平均随访19.6个月后的总死亡率为5%。急性心肌梗死患者行冠状动脉成形术风险较低，对于有溶栓治疗禁忌证或溶栓失败的患者似乎有益。
