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目的 评价老年急性ST段抬高性心肌梗死患者,在急诊静脉溶栓治疗后,对于梗死相关冠状动脉未能有效开通的病例,进行补救性冠状动脉介入治疗。方法 ≥70岁急性ST段抬高的心肌梗死(ST segmentelevationacutemyocardialinfarction ,STE AMI)患者5 2例(≥70岁组) ,在急诊静脉溶栓治疗后若判定梗死相关动脉未能有效开通,则即行冠状动脉造影,若造影显示梗死相关动脉血流为非TIMI 3级灌注、同时患者仍有较明显胸痛和(或)梗死对应心电图导联ST段抬高,并除外急诊冠状动脉介入治疗的禁忌证,即进行梗死相关冠状动脉的补救性介入治疗(包括球囊扩张、支架置入)。同时与<70岁的6 7例(<70岁组)STE AMI患者进行比较。结果 与<70岁组患者比较,≥70岁组的STE AMI患者在进行了静脉溶栓治疗后行急诊冠状动脉造影显示:溶栓有效开通比例低,同时在心肌梗死急性期的死亡绝对数较大;但梗死相关动脉经皮冠状动脉介入治疗(PCI)成功比例两组无差异,同时,在≥70岁组,接受了静脉溶栓治疗后,再行PCI的严重出血并发症(包括颅内出血、消化道大出血等)并未见增加。结论 ≥70岁组患者静脉溶栓有效开通比例较低,进行补救性PCI成功比例与<70岁组的STE AMI患者相同,在严密监测出、凝血参数情况下出现严重出血并发症低。
Objective To evaluate elderly patients with acute myocardial infarction (ST-elevation myocardial infarction). After emergency thrombolytic therapy, patients with infarct-related coronary arteries can not be effectively opened and treated with salvage coronary intervention. Methods Fifty-two patients (≥70 years old) with ST-segment elevation myocardial infarction (ST AMI) ≥70 years old were enrolled in this study. If the infarction-related artery was not found to be effective after emergency thrombolytic therapy, Arteriography, if angiography shows infarction-related arterial blood flow was non-TIMI grade 3 perfusion, while patients still have more obvious chest pain and (or) infarction corresponding ST segment elevation of the ECG lead, and except for emergency coronary intervention in contraindications, That interventional treatment of infarct-related coronary arteries (including balloon dilatation, stent placement). A comparison was also performed with 67 AMI patients <70 years old (<70 years old) STE AMI patients. Results Compared with patients under 70 years of age, STE AMI patients ≥70 years of age underwent emergency coronary angiography after intravenous thrombolytic therapy showed that: the effective thrombolytic opening ratio is low, while the absolute number of deaths in the acute stage of myocardial infarction However, there was no difference between the two groups in the success rate of percutaneous coronary intervention (PCI) for infarct-related artery. In the mean age of more than 70 years, patients receiving intravenous thrombolysis were followed by severe bleeding complications (including intracranial hemorrhage , Gastrointestinal bleeding, etc.) did not increase. Conclusions The proportion of successful thrombolytic therapy in patients ≥70 years old was lower, and the percentage of successful PCI was similar to that of STE AMI patients <70 years of age. Strictly monitored bleeding was associated with low bleeding with coagulation parameters.