【摘要】 目的观察既往经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者急诊PCI时罪犯病变的特点,推断这类患者AMI的发病机制。方法回顾性分析从2004年4月到2006年4月在阜外心血管病医院行急诊PCI治疗的61例既往PCI的AMI患者的临床资料。结果61例患者(62.1±10.0岁,男性88.5%)罪犯病变位置为左前降支(LAD)47.5%、右冠状动脉(RCA)39.5%、左回旋支(LCX)13.0%。在既往PCI1年后,除了阿司匹林的应用率无明显变化(93.8%比100%,P=0.113)外,全部患者均停用了氯吡格雷,应用β受体阻滞剂、血管紧张素转换酶抑制剂和他汀类调脂药的比率明显降低(与PCI后1年内比较,分别为46.9%比75.0%,P=0.001;34.4%比70.8%,P=0.001;28.1%比77.1%,P=0.000)。61例患者的罪犯病变特点:支架内急性和亚急性血栓形成12例(19.7%),晚期和晚晚期血栓形成6例(9.8%),非支架内血栓43例(70.5%),没有支架内再狭窄因素引起。AMI距既往PCI的时间:1个月以下者13例(21.3%),除了1例因术后3天在另一支冠状动脉发生斑块破裂外,其余均因支架内急性/亚急性血栓形成;1个月~1年者16例(26.2%),其中4例为晚期血栓形成,12例为非支架内血栓;1年以上者32例(52.5%),除了2例为支架内晚晚期血栓形成,其余30例均为非支架内血栓因素。结论既往PCI患者AMI的发病机制主要是斑块破裂。冠心病二级预防对减少PCI术后AMI的发生起重要作用。更多还原

【Abstract】 Objective To observe the characteristics of culprit lesions in AMI with previous PCI.Methods Retrospective analysis was carried out in 61 consecutive AMI patients with previous PCI treated with primary PCI from April, 2004 to April, 2006 in Fuwai hospital.Results Location of culprit lesions in the 61 patients (62.1±10.0 yrs; male 88.5%) were: LAD 47.5%, RCA 39.5%, LCX 13.0%. Comparing the medication of the patients during the first year after the former PCI, besides the continous use of aspirin (93.8% vs 100%,P=0.113), all patients had stopped using clopidogrel, and the use of β-blockers, ACEIs and statins also dropped significantly after 1 year (46.9% vs 75.0%, P= 0.001; 34.4% vs 70.8%, P= 0.001; and 28.1% vs 77.1%, P= 0.000, respectively). The characteristics of the culprit lesions included: acute and sub-acute in-stent thrombosis in 12 cases (19.7%), late and very late in-stent thrombosis in 6 cases (9.8%), plaque rapture in 41 cases (70.5%), but no restenosis was involved. The time of the recurrant AMI after the former PCI were: 13 cases (21.3%) within 1 month including 12 cases of acute or subacute in-stent thrombosis and 1 case of plaque rupture in anther coronary artery 3 days after primary PCI; 16 cases (26.2%) after the first month to 1 year including 12 cases of plaque rupture and 4 cases of late in-stent thrombosis; 32 cases (52.5%) 1 year including 30 cases of plaque rupture and 2 cases of very late in-stent thrombosis. Conclusion The major mechanism of recurrant AMI after preoious PCI is plaque rapture.更多还原