【摘要】 为评价急性心肌梗死(AMI)患者急诊经皮冠状动脉腔内成形(PTCA)和冠状动脉内支架植入围术期死亡和近期预后的影响因素,通过对74例行急诊冠状动脉内支架植入的AMI,术后6个月内的临床随访和冠状动脉造影随访,进行多因素相关回归分析。结果表明,多支病变患者的糖尿病、高血压和高血脂的合并比例明显高于单支病变患者;总围术期内死亡率为5.4％,剔除合并心源性休克患者后,死亡率为1.4％;12例75岁以上的患者中,2例死于心源性休克,1例死于心脏破裂,5例心源性休克患者死亡3例;术中非致命性合并症的发生率在单支和多支病变组之间差异无显著性(P>0.05);多元回归分析表明血流动力学状态和患者的年龄是决定AMI患者围术期死亡的独立相关因素;多支病变患者术后6个月内心脏事件发生率明显高于单支病变组;术前和术后6个月内的患者左心室射血分数(LVEF)明显改善;而且单支和多支病变组之间术后6个月时的LVEF之间无显著性差异。更多还原

【Abstract】 To determine the independent factors which correlates with periprocedural mortality and short - term prognosis, the present study prospectivelly analysed multiple factors including procedural complications and follow - up indexes in 74 patients with acute myocardial infarction during and after emergent coronary endovascular stenting. The results demonstrated that most patients with multi - vessel diseases had high rate of diabetes, hypertension and hyper-lipidemia. The total death rate was 5.4%, with net death rate 1.4% after cardiac shock excluded. Among 12 patients aged>75 years, 2 cases with cardiac shock and 1 non - shock case died within 1 week post - procedure. There was no difference of non- fatal complications including reversible dissection, reperfusion arrhythemias and no- reflow between the patients with multivessel and single vessel diseases. In 5 cases with cardiac shock, 3 cases died. Multistep regression analysis demonstrated cardiac shock (unstable hemodynamics ) and old age were two independent factors correlated with peri - procedural death and suboptimal short - term prognosis. Significant improvement in left ventricular eject fraction (LVEF) observed after procedure. In conclusion: Primary coronary stenting and rescue stenting were feasible and useful approaches for patients with acute myocardial infarction, Hemodynamics and patients age were two independent factors correlated with peri - procedural death and short - term prognosis.更多还原