Pomar Domingo F, Pérez Fernández E, Quesada Dorador A, Atienza Fernández F, Vilar Herrero J V, Echánove Errazti I, de Velasco Rami J
Servicio de Cardiología, Hospital General Universitario de Valencia.
Rev Esp Cardiol. 1997 Apr;50(4):248-53.
Stent implantation has been generally contraindicated during primary percutaneous transluminal balloon angioplasty in AMI, because of its possible trombogenicity. Report the early outcome of patients undergoing coronary stenting during primary PTCA.
From january 1995 to april 1996, 31 patients underwent stent implantation in primary. Mean age 62 +/- 11 years. Infarct location was anterior in 20 (65%), and inferior in 11 patients (35%). Four patients were in Killip class IV. Mean onset of chest pain was 129 +/- 29 minutes. Indications for stenting were suboptimal result (64%), dissection (29%) and elective (6%). All patients were treated with heparin during 72 hours and antiplatelet therapy with ticlopidine and aspirin.
Coronary stenting restored vessel patency with TIMI 3 flow in 29 patients (94%) and TIMI 2 flow in 2 patients. Angiographic control was performed in 80% of the patients: no stent occlusion was observed and all patients showed a TIMI 3 flow. There were 3 deaths (9%): 2 patients died due to cardiogenic shock and 1 to severe right ventricular dysfunction. 2 patients (6%) had recurrent angina, due to other artery. One patient with left main coronary disease underwent elective coronary artery bypass graft surgery.
Intracoronary stent can be used successfully during primary angioplasty with a low incidence of complications. The long term benefits remains to be established.
由于支架植入可能具有血栓形成性，在急性心肌梗死的直接经皮腔内冠状动脉成形术（PTCA）期间，一般禁忌使用支架植入。报告在直接PTCA期间接受冠状动脉支架植入患者的早期结果。
1995年1月至1996年4月，31例患者直接接受了支架植入。平均年龄62±11岁。梗死部位在前壁的有20例（65%），下壁的有11例（35%）。4例患者为Killip IV级。胸痛平均发作时间为129±29分钟。支架植入的指征为效果欠佳（64%）、夹层形成（29%）和择期手术（6%）。所有患者在72小时内接受肝素治疗，并使用噻氯匹定和阿司匹林进行抗血小板治疗。
冠状动脉支架植入使29例患者（94%）的血管恢复通畅，TIMI血流3级，2例患者为TIMI血流2级。80%的患者进行了血管造影复查：未观察到支架闭塞，所有患者均显示TIMI血流3级。有3例死亡（9%）：2例患者死于心源性休克，1例死于严重右心室功能不全。2例患者（6%）因其他动脉病变出现复发性心绞痛。1例左主干冠状动脉疾病患者接受了择期冠状动脉搭桥手术。
冠状动脉内支架可在直接血管成形术期间成功使用，并发症发生率较低。其长期益处仍有待确定。
