She Li-Qiong, Gao De-Kui, Hong Le, Tian Yin, Wang Hui-Zhen, Huang Sheng
Department of Critical Care Medicine, Jiangyou Second People's Hospital, Jiangyou 621701, Sichuan Province, China.
Department of Cardiology, Jiangyou Second People's Hospital, Jiangyou 621701, Sichuan Province, China.
World J Cardiol. 2024 Sep 26;16(9):531-541. doi: 10.4330/wjc.v16.i9.531.
The combination of acute ST-segment elevation myocardial infarction (STEMI) and gastric ulcers poses a challenge to primary percutaneous coronary intervention (PPCI), particularly for young patients. The role of drug-coated balloons (DCBs) in the treatment of de novo coronary artery lesions in large vessels remains unclear, especially for patients with STEMI. Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion.
A 54-year-old male patient presented to the emergency department due to chest pain on June 24, 2019. Within the first 3 minutes of the initial assessment in the emergency room, the electrocardiogram (ECG) showed significant changes. There was atrial fibrillation with ST-segment elevation. Subsequently, atrial fibrillation terminated spontaneously and reverted to sinus rhythm. Soon after, the patient experienced syncope. The ECG revealed torsades de pointes ventricular tachycardia. A few seconds later, it returned to sinus rhythm. High-sensitivity tropon in I was normal. The diagnosis was acute STEMI. Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery. Considering the patient's age and history of peptic ulcer disease, after the intracoronary injection of prourokinase, percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning, and paclitaxel drug-eluting balloon angioplasty was performed without any stents, achieving favorable outcomes.
A PPCI without stents may be a viable treatment strategy for select patients with STEMI, and further research is warranted.
急性ST段抬高型心肌梗死（STEMI）合并胃溃疡对直接经皮冠状动脉介入治疗（PPCI）构成挑战，尤其是对年轻患者。药物涂层球囊（DCB）在大血管新发冠状动脉病变治疗中的作用仍不明确，特别是对于STEMI患者。我们的策略是在冠状动脉内注射低剂量尿激酶原并进行充分预扩张后实施药物球囊血管成形术。
一名54岁男性患者于2019年6月24日因胸痛就诊于急诊科。在急诊室初始评估的前3分钟内，心电图（ECG）显示出显著变化。存在房颤伴ST段抬高。随后，房颤自发终止并恢复为窦性心律。不久后，患者发生晕厥。心电图显示尖端扭转型室性心动过速。几秒钟后，又恢复为窦性心律。肌钙蛋白I高敏检测结果正常。诊断为急性STEMI。急诊冠状动脉造影显示左前降支近端次全闭塞并形成血栓。考虑到患者的年龄和消化性溃疡病史，在冠状动脉内注射尿激酶原后，进行了经皮冠状动脉腔内血管成形术和切割球囊血管成形术以进行充分预处理，然后在未置入任何支架的情况下进行了紫杉醇药物洗脱球囊血管成形术，取得了良好效果。
对于某些STEMI患者，无支架的PPCI可能是一种可行的治疗策略，值得进一步研究。
