Haraguchi Yumiko, Sakakura Kenichi, Yamamoto Kei, Taniguchi Yousuke, Nakashima Ikue, Wada Hiroshi, Sanui Masamitsu, Momomura Shin-Ichi, Fujita Hideo
Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University.
Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University.
Int Heart J. 2018 Mar 30;59(2):407-412. doi: 10.1536/ihj.17-173. Epub 2018 Feb 23.
Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.
钝性胸部创伤可导致多种损伤，包括急性心肌梗死（AMI）。虽然钝性胸部创伤引起冠状动脉夹层导致的AMI非常罕见，但它与高发病率和死亡率相关。在绝大多数AMI患者中，进行了初级经皮冠状动脉介入治疗（PCI）以再通阻塞的动脉，但PCI在创伤急性期有大量出血并发症的风险。我们报告一例钝性胸部创伤导致右冠状动脉（RCA）夹层引起的AMI病例。完全阻塞的RCA通过药物治疗自发再通。由于心电图显示早期再灌注迹象，我们在钝性胸部创伤急性期避免了初级PCI。当出血风险消退的亚急性期，我们进行了择期PCI。由于与后期相比，钝性胸部创伤急性期严重出血并发症的风险更大，如果观察到再通迹象，推迟紧急PCI是合理的。
