Stone G W, Rutherford B D, McConahay D R, Johnson W L, Giorgi L V, Ligon R W, Hartzler G O
Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
J Am Coll Cardiol. 1990 Mar 1;15(3):534-43. doi: 10.1016/0735-1097(90)90621-u.
Percutaneous transluminal coronary angioplasty was performed as primary therapy in 215 consecutive patients (aged 56 +/- 11 years, 75% male) with acute myocardial infarction and single vessel coronary artery disease. Wide patency of the infarct-related artery was restored in 212 patients (99%). Complications consisted of one urgent coronary bypass operation (0.5%); there were no procedural deaths. A recurrent ischemic event before discharge occurred in eight patients (4%). The in-hospital mortality rate was 1%; five of six patients presenting with cardiogenic shock were alive at discharge. In 126 patients in whom predischarge angiography was performed, the ejection fraction improved from 55 +/- 12% to 61 +/- 12% (p less than 0.005) and increased by greater than or equal to 5% units in 66 patients (52%). Regional wall motion improved in 60 patients (48%). By multivariate analysis, a depressed initial ejection fraction, a limited increase in serum creatine kinase, young age and sustained patency of the infarct-related artery were found to be independent predictors of improvement in left ventricular function. Follow-up data were available in 214 patients (99.5%) at a mean interval of 35 months. The actuarial 3 year cardiac survival rate was 92%. By multivariate analysis, only the baseline ejection fraction correlated with long-term cardiac survival. Nine patients (4%) sustained a late nonfatal myocardial infarction, and 11 patients (5%) underwent subsequent coronary bypass surgery. At late follow-up study, 149 (77%) of 194 patients alive were free of angina. In summary, in patients with acute myocardial infarction and single vessel disease, coronary angioplasty without prior thrombolytic therapy can be performed with a high success rate and few procedural complications. After direct angioplasty, regional wall motion and global ejection fraction improve in 50% of patients, especially in those with depressed initial left ventricular function. This approach results in an excellent early and late event-free survival.
对215例连续的急性心肌梗死合并单支冠状动脉疾病患者（年龄56±11岁，75%为男性）进行经皮腔内冠状动脉成形术作为初始治疗。212例患者（99%）梗死相关动脉恢复了广泛通畅。并发症包括1例急诊冠状动脉搭桥手术（0.5%）；无手术死亡。8例患者（4%）出院前发生复发性缺血事件。住院死亡率为1%；6例心源性休克患者中有5例出院时存活。在126例行出院前血管造影的患者中，射血分数从55±12%提高到61±12%（p<0.005），66例患者（52%）增加≥5个百分点。60例患者（48%）局部室壁运动改善。多因素分析显示，初始射血分数降低、血清肌酸激酶升高受限、年轻以及梗死相关动脉持续通畅是左心室功能改善的独立预测因素。214例患者（99.5%）有随访数据，平均随访间隔35个月。3年心脏精算生存率为92%。多因素分析显示，仅基线射血分数与长期心脏生存相关。9例患者（4%）发生晚期非致命性心肌梗死，11例患者（5%）接受了后续冠状动脉搭桥手术。在晚期随访研究中，194例存活患者中有149例（77%）无心绞痛。总之，对于急性心肌梗死合并单支血管病变的患者，不进行溶栓预处理的冠状动脉成形术成功率高且手术并发症少。直接血管成形术后，50%的患者局部室壁运动和整体射血分数改善，尤其是初始左心室功能降低的患者。这种方法可带来优异的早期和晚期无事件生存率。
