高龄（80-89 岁）非ST 段抬高心肌梗死早期 介入治疗的疗效观察

目的:研究调查高龄(80-89岁)非ST段抬高心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者行早期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的有效性。方法:回顾分析2008年8月-2009年10月期间我院住院的66例80-89岁NSTEMI患者,冠状动脉造影检查后45例行PCI术,5例因为左主干病变或者严重的三支病变行冠脉搭桥(CABG)术,其余16例做保守治疗。发病到行介入治疗时间<72h。结果:45例行PCI术中42例成功,再血管化的成功率为63.6%,失败的3例PCI术病人中2例因导丝或球囊未能通过病变,1例为顽固性室速。共植入支架80枚,术后梗死相关动脉血流均达到TIMI2-3级。术后死亡2例(心源性休克、颅内出血各1例),死亡率为4.8%。住院期间出血并发症较高,有4(9.5%)例(穿刺部位血肿2例,消化道、颅内出血各1例)。住院期间无再发心肌梗死,偶发心绞痛2例。结论:穿刺尽管高龄(80-89岁)非ST段抬高心肌梗死冠脉早期介入主要出血事件较多,但可改善住院期间的预后。

Observe the Effect of Early Percutaneous Coronary Intervention on Octogenarian with Non-ST-Segment Elevation Myocardial Infarction

Objective: To investigate the efficacy of early percutaneous coronary intervention on octogenarian with Non-ST-seg-ment elevation myocardial infarction(NSTEMI).Methods:Between Aug.2008 and Oct.2009,66 NSTEMI patients were admitted in octogenarian(between 80 and 89 years old).underwent coronary artery angiography.45 patients performed early percutaneous coronary intervention(PCI) and 5 patients selected coronary artery bypass grafting(CABG) because of left main coronary lesion or severe triple-vessel lesion,the left 16 patients received conservative treatment.All patients was to treat within 72h.Results: In the invasive treatment,42 cases got success with the rate of recanalization in 63.6%;2 cases failed for that the guidewire or balloon could not cross the stenotic lesion and another failed for refractory ventricular tachycardia.A total of 80 stents were implanted.The flow of IRA(infarction related artery,IRA) reached TIMI 2-3 postoperative in successful PCI cases.One case died of cardiogenic shock and another of intracranial hemorrhage,with the rate of 4.8%.There was a high bleeding complications rate of 9.5%(two cases with puncture point hematoma,one with gastro-intestinal bleeding and one with intracranial hemorrhage).No reinfarction occurred during hospital stay.Only two cases accidentally suffered from angina.Conclusion: Despite of bleeding complications,early percutaneous coronary intervention have an improved prognosis for octogenarian in hospital.