Garcia-Cantu E, Spaulding C, Corcos T, Hamda K B, Roussel L, Favereau X, Guérin Y, Souffrant G, Guérin F
Hôpital Cochin, Université René Descartes, Paris.
Am J Cardiol. 1996 Mar 1;77(7):451-4. doi: 10.1016/s0002-9149(97)89336-8.
Among 138 patients treated with coronary angioplasty during acute myocardial infarction (AMI), 35 (25%) had stent implantation. Mean age was 56 years and 83% were men. Mean onset of chest pain was 6.0 +/- 5.3 hours, and previous thrombolytic therapy was given to 10 patients (29%). Infarct location was anterior in 19 (54%), inferior in 14 (40%), and lateral in 2 patients (6%). Thrombolysis in Myocardial Infarction trial flows 0,1, and 2 were seen in 24 (69%), 6 (17%), and 5 patients (14%), respectively. The culprit vessel was the left anterior descending artery in 18 (51%), right coronary artery in 14 (40%), left circumflex in 2 (6%), and left main coronary artery in 1 patient (3%). Mean vessel diameter was 3.3 +/- 0.3 mm. Indications were: primary in 5 (14%), suboptimal result in 8 (23%), nonocclusive dissection in 14 (40%), and occlusive dissection in 8 patients (23%). Angiographic thrombus after initial angioplasty was present in 12 patients (34%). A total of 46 stents were implanted; mean balloon diameter and pressure were 3.4 +/- 0.4 mm and 15.5 +/- 2.2 atm, respectively. Residual diameter stenosis was 4 +/- 7%. There were 2 deaths; sudden 1, and after elective coronary artery bypass grafting in the other; 2 patients (6%) had groin hematomas. Mean hospitalization was 9.9 +/- 5.0 days. Repeat angiography revealed no stent occlusion. With initial intravenous heparin for 3 to 7 days, all patients received aspirin and ticlopidine for 1 month. Thus, AMI is not a contraindication for stent implantation. The benefits of stenting are a high success rte, low residual diameter stenosis, and low incidence of in-hospital recurrent ischemia. Reduction in restenosis rate in this setting is likely but remains to be determined.
在138例急性心肌梗死（AMI）期间接受冠状动脉血管成形术治疗的患者中，35例（25%）进行了支架植入。平均年龄为56岁，83%为男性。胸痛平均发作时间为6.0±5.3小时，10例患者（29%）接受过溶栓治疗。梗死部位在前壁的有19例（54%），下壁的有14例（40%），侧壁的有2例（6%）。心肌梗死溶栓试验血流0、1和2级分别见于24例（69%）、6例（17%）和5例（14%）。罪犯血管为左前降支的有18例（51%），右冠状动脉的有14例（40%），左旋支的有2例（6%），左冠状动脉主干的有1例（3%）。平均血管直径为3.3±0.3毫米。适应证为：直接PCI 5例（14%），效果欠佳8例（23%），非闭塞性夹层14例（40%），闭塞性夹层8例（23%）。初次血管成形术后血管造影显示有血栓的患者有12例（34%）。共植入46枚支架；平均球囊直径和压力分别为3.4±0.4毫米和15.5±2.2个大气压。残余直径狭窄为4±7%。有2例死亡；1例猝死，另1例在择期冠状动脉旁路移植术后死亡；2例患者（6%）出现腹股沟血肿。平均住院时间为9.9±5.0天。重复血管造影显示无支架闭塞。初始静脉注射肝素3至7天，所有患者均接受阿司匹林和噻氯匹定治疗1个月。因此，AMI并非支架植入的禁忌证。支架植入的益处包括成功率高、残余直径狭窄低以及院内复发性缺血发生率低。在这种情况下，再狭窄率可能会降低，但仍有待确定。
