Krakau I, Schulze-Waltrop N, Arens R, Willgeroth W, Heuer H
Medizinische Klinik--Schwerpunkt für Kardiologie, Nephrologie und Intensivmedizin, St.-Johannes-Hospital, Dortmund.
Dtsch Med Wochenschr. 1996 Jul 12;121(28-29):896-901. doi: 10.1055/s-2008-1043084.
Percutaneous transluminal coronary angioplasty (PTCA) is being increasingly considered as an alternative to thrombolytic treatment of acute myocardial infarction. Studies performed so far, some on selected groups of patients, have produced high initial results of success. This prospective study was undertaken to determined primary success, complications and recurrence after primary PTCA in acute myocardial infarction (AMI).
Primary treatment in the form of immediate PTCA of the infarct vessel was undertaken in 111 patients (84 men, 27 women; mean age 58.6 +/- 10.3 years) with AMI. PTCA was judged successful if the infarct vessel had been reopened to perfusion grade 3 and restenosis was < 50%. No thrombolytic treatment was given, but heparin infusions were given during and for 24-48 hours after the procedure. 13 patients (11.7%) were in cardiogenic shock or required cardiopulmonary resuscitation for infarct-related arrhythmias.
The primary success rate of PTCA for the whole group was 91% (101 of 111 patients), but only 77% (ten of 13) among patients in cardiogenic shock and (or) after resuscitation. Acute re-occlusion (0-6 days after PTCA) occurred in seven patients. Eight patients (7.2%) died during the hospital phase (0-4 weeks), seven of whom had been in shock or required resuscitation (death rate 54%). The overall complication rate of the intervention was 6.3%. No emergency aortocoronary bypass was necessary. Repeat coronary angiography was performed in 71 of the 101 successfully treated patients 6 or 12 weeks after the PTCA. Re-occlusion was demonstrated in four (5.6%), a restenosis of more than 50% in 25% of patients. Mean left ventricular ejection fraction, obtained by planimetry from the levocardiogram was 58.6 +/- 9.3%.
PTCA, performed immediately after acute myocardial infarction is an effective therapeutic measure with a high primary success rate.
经皮腔内冠状动脉成形术（PTCA）越来越多地被视为急性心肌梗死溶栓治疗的替代方法。迄今为止所进行的研究，有些是针对特定患者群体的，取得了较高的初始成功率。这项前瞻性研究旨在确定急性心肌梗死（AMI）患者接受初次PTCA后的初次成功率、并发症及复发情况。
对111例AMI患者（84例男性，27例女性；平均年龄58.6±10.3岁）采用梗死相关血管直接PTCA的形式进行初始治疗。若梗死相关血管重新开通至灌注3级且再狭窄<50%，则判定PTCA成功。未给予溶栓治疗，但在手术期间及术后24 - 48小时给予肝素输注。13例患者（11.7%）出现心源性休克或因梗死相关心律失常需要进行心肺复苏。
整个组PTCA的初次成功率为91%（111例患者中的101例），但在心源性休克和（或）复苏后的患者中仅为77%（13例中的10例）。7例患者发生急性再闭塞（PTCA后0 - 6天）。8例患者（7.2%）在住院期间（0 - 4周）死亡，其中7例曾处于休克状态或需要复苏（死亡率54%）。该干预的总体并发症发生率为6.3%。无需进行急诊主动脉冠状动脉旁路移植术。在101例成功治疗的患者中，71例在PTCA后6或12周进行了重复冠状动脉造影。4例（5.6%）显示再闭塞，25%的患者再狭窄超过50%。通过心脏超声心动图平面测量获得的平均左心室射血分数为58.6±9.3%。
急性心肌梗死后立即进行PTCA是一种有效的治疗措施，初次成功率高。
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