Murdock D K, Logemann T, Hoffmann M T, Olson K J, Engelmeier R S
Cardiovascular Associates of Northern Wisconsin, Wausau, USA.
Cathet Cardiovasc Diagn. 1997 Oct;42(2):173-9. doi: 10.1002/(sici)1097-0304(199710)42:2<173::aid-ccd16>3.0.co;2-p.
Emergent percutaneous transluminal coronary angioplasty (PTCA) is an effective treatment for acute myocardial infarction. However, occasionally results of angioplasty are suboptimal due to coronary dissection or elastic recoil, leading to a high chance of recurrent ischemia. Coronary stents are occasionally employed in such settings, but a high incidence of stent thrombosis was noted by early investigators when stents were placed into areas of active thrombus formation. Since coronary thrombosis and stent thrombosis are both initiated by platelets, the potent antiplatelet agent abciximab might be useful in preventing stent thrombosis. Little information is available concerning early outcome or 6-month clinical event rate when coronary artery stents are placed for suboptimal angioplasty results for acute myocardial infarction in patients given abciximab. We deployed 75 stents as part of angioplasty for acute myocardial infarction in 40 patients given abciximab. All patients had suboptimal angioplasty results leading to stent deployment. Each obtained normal flow angiographically and no stent thrombosis or acute closure was observed. Early mortality occurred in 1 patient. All patients were followed at least 6 months, and no patient died after hospital discharge. Three patients experienced recurrent ischemic events within the first 6 months. Two of these events were due to infarct vessel restenosis. We conclude the combined use of coronary artery stents and abciximab for suboptimal PTCA results during acute myocardial infarction is associated with a low incidence of culprit vessel recurrent ischemic events within 6 months of intervention.
急诊经皮冠状动脉腔内血管成形术（PTCA）是治疗急性心肌梗死的有效方法。然而，由于冠状动脉夹层或弹性回缩，血管成形术的效果偶尔会不理想，导致反复缺血的可能性很高。在这种情况下偶尔会使用冠状动脉支架，但早期研究人员发现，当将支架置入有活跃血栓形成的区域时，支架血栓形成的发生率很高。由于冠状动脉血栓形成和支架血栓形成均由血小板引发，强效抗血小板药物阿昔单抗可能有助于预防支架血栓形成。对于接受阿昔单抗治疗的急性心肌梗死患者，因血管成形术效果不理想而置入冠状动脉支架时，关于早期结局或6个月临床事件发生率的信息很少。我们对40例接受阿昔单抗治疗的急性心肌梗死患者进行血管成形术时置入了75个支架。所有患者的血管成形术效果均不理想，因此需要置入支架。每个患者血管造影均获得正常血流，未观察到支架血栓形成或急性闭塞。1例患者发生早期死亡。所有患者均至少随访6个月，出院后无患者死亡。3例患者在最初6个月内发生反复缺血事件。其中2例事件是由于梗死血管再狭窄。我们得出结论，在急性心肌梗死期间，对于血管成形术效果不理想的情况，联合使用冠状动脉支架和阿昔单抗与干预后6个月内罪犯血管反复缺血事件的低发生率相关。
