Helmreich G, Kratzer H, Baumgartner H, Kühn P
II. Interne Abteilung/Kardiologie, Krankenhaus der Barmherzigen Schwestern, Linz.
Wien Klin Wochenschr. 1994;106(16):507-12.
We report our experience with primary angioplasty (PPTCA) in acute myocardial infarction performed without prior thrombolytic therapy. Between January 1991 and April 1993, 44 patients underwent PPTCA. Duration of symptoms was 163 +/ 106 min; age range of patients was 30 to 89 years (mean 60.6 +/- 13.5 years). Twelve patients presented with cardiogenic shock (27%), 17 patients (39%) had at least one relative contraindication for thrombolysis. Primary success rate was 98%. No stroke or major bleeding was observed. Reocclusion occurred in two patients, whereby this complication was silent in one of the cases. Significant residual stenosis remained in two additional patients. Three patients (7%) underwent elective bypass surgery (ACBG). Overall two-week mortality was 9%, and only 3% in the subgroup of patients without cardiogenic shock. Complete follow-up (FU) exceeding four months is now available in 36 patients (mean FU 13.7 +/- 7.3 months). During the FU period three patients had ACBG and five patients had PTCA. Thus, seven of 36 patients (19%) needed an additional procedure. Three patients had died, all of them were older than 70 years and initially presented with cardiogenic shock. Overall survival (in hospital and FU) was 84% (97% when patients with cardiogenic shock were excluded). Long-term survival (in hospital and FU) of the twelve patients initially presenting with cardiogenic shock was 50%. In conclusion, PPTCA is a promising therapeutic option in patients with acute myocardial infarction, especially when thrombolysis is contraindicated or when cardiogenic shock is present. It appears to be feasible even in centers with only one available catheterization unit.
我们报告了在未进行预先溶栓治疗的情况下对急性心肌梗死患者进行直接经皮冠状动脉腔内血管成形术（PPTCA）的经验。1991年1月至1993年4月期间，44例患者接受了PPTCA。症状持续时间为163±106分钟；患者年龄范围为30至89岁（平均60.6±13.5岁）。12例患者出现心源性休克（27%），17例患者（39%）至少有一项溶栓相对禁忌证。直接成功率为98%。未观察到中风或大出血。两名患者发生再闭塞，其中一例该并发症无临床表现。另外两名患者存在显著残余狭窄。3例患者（7%）接受了择期冠状动脉搭桥手术（ACBG）。总体两周死亡率为9%，无心源性休克的患者亚组中仅为3%。目前36例患者有超过4个月的完整随访（FU）（平均FU 13.7±7.3个月）。在随访期间，3例患者接受了ACBG，5例患者接受了PTCA。因此，36例患者中有7例（19%）需要额外的手术。3例患者死亡，均年龄大于70岁，最初表现为心源性休克。总体生存率（住院和随访）为84%（排除心源性休克患者时为97%）。最初表现为心源性休克的12例患者的长期生存率（住院和随访）为50%。总之，PPTCA对于急性心肌梗死患者是一种有前景的治疗选择，尤其是在溶栓禁忌或存在心源性休克时。即使在只有一个可用导管室的中心，它似乎也是可行的。
