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目的 :探讨老年人急性心肌梗死 (AMI)急诊经皮冠状动脉腔内成形术的成功率及近期预后。方法 :对 1994年以来收治的 6 3例 (男 5 2例 ,女 11例 ,年龄 6 0～ 76岁 )老年人AMI进行了急诊PTCA ,其中直接PTCA 42例 ,补救性PTCA 2 1例 ,观察手术前后患者梗塞相关动脉 (IRA)狭窄程度、TIMI血流、近期存活率及部分患者心功能状况。结果 :6 3例老年人AMI经冠状动脉造影发现IRA 70段 ,急诊PTCA后完全再通 6 6段 ,成功率 94 3% ,3例中的 4段IRA未获成功。术后残余狭窄 (0 %～ 2 0 % )较术前狭窄 (95 %～ 10 0 % )程度明显改善 (P <0 0 0 1) ,均恢复TIMI 3级血流。除 2例于住院期间死亡 (占 3 2 % )外 ,其余患者全部存活 ,9例合并低血压状态或心源性休克及 10例合并心功能不全 (NYHAⅡ～Ⅲ级 )患者术后临床症状改善。术后 3个月左右无再梗死及猝死发生。结论 :急诊PTCA治疗老年人AMI成功率高 ,住院病死率低 ,近期预后良好 ,故是老年人AMI有效的治疗手段
Objective: To investigate the success rate and short-term prognosis of elderly patients with acute myocardial infarction (AMI) undergoing percutaneous transluminal coronary angioplasty. Methods: Acute PTCA was performed on 63 AMI patients (52 males, 11 females and 6 0 to 76 years old) admitted to the hospital since 1994. There were 42 cases of direct PTCA and 21 cases of remedial PTCA. Preoperative and postoperative patients with infarct related artery (IRA) stenosis, TIMI flow, recent survival and cardiac function in some patients. Results: Sixty-three IRA segments were found in 63 elderly patients with coronary artery angiography (AMI). Sixty-three patients were successfully recanalized after PTCA. The success rate of IRA was 94.3%. No IRA in four of the three patients was successful. Postoperative residual stenosis (0% ~ 20%) was significantly improved compared with preoperative stenosis (95% ~ 100%) (P <0.01 01), and TIMI 3 grade blood flow was recovered. All patients survived except for 2 deaths (32%) during hospitalization. Nine patients with combined hypotension or cardiogenic shock and 10 patients with NYHA Ⅱ ~ Ⅲ improved clinical symptoms . No further infarction and sudden death occurred about 3 months after operation. Conclusions: The success rate of AMI in the treatment of elderly patients with emergency PTCA is high, the in-hospital mortality rate is low and the prognosis is good in the near future, so it is an effective treatment for AMI in the elderly