O'Keefe J H, Rutherford B D, McConahay D R, Ligon R W, Johnson W L, Giorgi L V, Crockett J E, McCallister B D, Conn R D, Gura G M
Cardiovascular Consultants, Kansas City, Missouri 64111.
Am J Cardiol. 1989 Dec 1;64(19):1221-30. doi: 10.1016/0002-9149(89)90558-4.
Direct coronary angioplasty without antecedent thrombolytic therapy was performed in 500 consecutive patients with acute myocardial infarction. Anterior and inferior infarctions were noted in 217 and 283 patients, respectively. Two hundred fifteen patients (43%) had 1-vessel disease, 85 patients (17%) were greater than 70 years of age and 39 (8%) presented in cardiogenic shock. Successful angioplasty of the infarct vessel was achieved in 94% of patients. The overall in-hospital mortality was 7.2%. Cardiogenic shock, 3-vessel disease and failed angioplasty were the 3 strongest multivariate correlates of early mortality. Reocclusion of the infarct-vessel was noted in 47 (15%) of the 307 patients with angiographic follow-up before hospital discharge. Significant bleeding complications occurred in only 3% of patients; stroke or myocardial rupture was not seen. The global ejection fraction increased from 53% on the preangioplasty ventriculograms to 59% at 1 week (p less than 0.001). Significant regional wall motion improvement in the infarct segments was noted in 53% of patients. Global ejection fraction improved most dramatically in patients presenting with baseline ejection fractions less than or equal to 45% (increasing from 36 to 50%). The 1- and 5-year survival rates after hospital discharge were 95 and 84%, respectively. The 1-year reinfarction rate was 3%. Thus, direct coronary angioplasty was highly effective in reestablishing infarct-vessel patency and salvaging ischemic myocardium, resulting in low in-hospital and long-term mortality.
对500例连续性急性心肌梗死患者进行了未先行溶栓治疗的直接冠状动脉血管成形术。分别有217例和283例患者出现前壁和下壁梗死。215例患者（43%）有单支血管病变，85例患者（17%）年龄大于70岁，39例患者（8%）出现心源性休克。94%的患者梗死血管血管成形术成功。住院总死亡率为7.2%。心源性休克、三支血管病变和血管成形术失败是早期死亡的3个最强多变量相关因素。在307例出院前接受血管造影随访的患者中，有47例（15%）出现梗死血管再闭塞。仅3%的患者发生严重出血并发症；未观察到中风或心肌破裂。整体射血分数从血管成形术前心室造影的53%增加到1周时的59%（p<0.001）。53%的患者梗死节段出现显著的局部室壁运动改善。基线射血分数小于或等于45%的患者整体射血分数改善最为显著（从36%增加到50%）。出院后1年和5年生存率分别为95%和84%。1年再梗死率为3%。因此，直接冠状动脉血管成形术在恢复梗死血管通畅和挽救缺血心肌方面非常有效，导致较低的住院死亡率和长期死亡率。
