Villavicencio Fernández R, Marchena Noriega A, Eid Lidt G, Martín del Campo A L, Peña Duque M A, Gaspar Hernández J, Ban Hayashi E, Ariza González H, Martínez Ríos M A
Departamento de Hemodinámica, Instituto Nacional de Cardiología Ignacio Chávez INCICH, México, D.F.
Arch Inst Cardiol Mex. 1998 Jan-Feb;68(1):18-26.
From December 1995 to March 1997 fifty patients with acute myocardial infarction, had 57 stents implanted. Mean time since the beginning of symptoms to the procedure was 3.7 +/- 2.9 hours. Twenty-four stents were implanted "de novo", 17 for "sub-optimal" results, 5 for threatened closure and eleven for complex dissection. The arteries treated with stent were left anterior descending in 42%, right coronary in 42%, circumflex in 10%, vein grafts in 4%, intermedial branch in 1% and marginal obtuse branch in 1%. Stent used in most of the cases was AVE in 67% followed by Palmaz-Schatz, Wiktor, Crown, Gianturco-Roubin and Wallstent. Before procedure, coronary flow was TIMI 0 in 66% TIMI 1 in 10% and TIMI 2 in 24%. After procedure, TIMI 3 coronary flow was achieved in 92% of the arteries and other four had "no-reflow" phenomenon. Mean stenosis before procedure was 96% +/- 3.1 and after stenting was 1.76% +/- 2.6 with a stent/artery diameter rate of 1.01. Technical success was 100% and clinical success was achieved in 96% of the cases. Two cases were not successfully due to acute thrombotic closure in one patient and in another one because of cardiogenic shock after two days of a technical successful implantation of stent in LAD artery. There were not recurrent ischemic events (CABG, re-infarction or new coronary angioplasty procedure). Other two patients died for non-cardiac events (acute pancreatitis in one and by septic shock in other). At the time of discharge 96% of patients were treated with aspirin and ticlopidine. Major hematoma was evident in only one case. At a mean follow-up time of 5.6 months +/- 4.2 in 45 patients showed that 73% were in functional class I and none of them had re-infarction, death or needed a new revascularization.
Stent implantation in acute myocardial infarction is feasible and safe procedure with a low rate of ischemic recurrent events.
1995年12月至1997年3月，50例急性心肌梗死患者植入了57枚支架。从症状开始到手术的平均时间为3.7±2.9小时。“初次”植入24枚支架，17枚用于“效果欠佳”情况，5枚用于预防血管闭合，11枚用于复杂夹层。接受支架治疗的动脉中，左前降支占42%，右冠状动脉占42%，回旋支占10%，静脉桥血管占4%，中间支占1%，钝缘支占1%。大多数病例使用的支架是AVE，占67%，其次是Palmaz-Schatz、Wiktor、Crown、Gianturco-Roubin和Wallstent。术前，冠状动脉血流TIMI 0级占66%，TIMI 1级占10%，TIMI 2级占24%。术后，92%的动脉实现了TIMI 3级冠状动脉血流，另外4例出现“无复流”现象。术前平均狭窄率为96%±3.1，支架植入后为1.76%±2.6，支架/动脉直径比为1.01。技术成功率为100%，96%的病例取得了临床成功。2例未成功，1例患者因急性血栓性闭塞，另一例在左前降支动脉支架植入技术成功两天后因心源性休克导致失败。没有复发性缺血事件（冠状动脉搭桥术、再梗死或新的冠状动脉成形术）。另外2例患者死于非心脏事件（1例为急性胰腺炎，另1例为感染性休克）。出院时，96%的患者接受了阿司匹林和噻氯匹定治疗。仅1例出现明显的大血肿。45例患者平均随访时间为5.6个月±4.2个月，结果显示73%的患者心功能为I级，且无一例发生再梗死、死亡或需要新的血运重建。
急性心肌梗死患者植入支架是一种可行且安全的手术，缺血性复发事件发生率较低。
