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目的分析急性心肌梗死患者行急诊经皮冠状动脉介入治疗(PCI)手术中及住院期间死亡原因。方法1999年3月至2005年6月行急诊PCI治疗的急性心肌梗死患者623例,死亡27例,回顾性分析其死亡原因及临床特征。结果死亡27例,病死率4．3%,年龄51～91岁,(69±18)岁。三支病变16例．二支病变10例．单支病变1例。合并陈旧心肌梗死10例,糖尿病9例．高血压病19例,肾功能损害4例,陈旧性脑梗死6例。死亡原因：心源性休克9例,无复流6例,心脏破裂2例,急性血栓形成2例,急性左心功能衰竭2例,急性肾功能衰竭2例,颅内出血2例,穿刺处出血致休克1例,急性心包填塞1例。结论急性心肌梗死急诊介入治疗死亡原因有多种,心源性休克、无复流为主要死亡原因。高龄、多支病变、合并糖尿病、陈旧性心肌梗死等可能为死亡的预测因子。
Objective To analyze the causes of death during emergency and percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. Methods From March 1999 to June 2005, 623 acute myocardial infarction patients undergoing emergency PCI were treated and 27 died. The causes of death and clinical features were retrospectively analyzed. Results of 27 cases of death, the mortality rate of 4.3%, aged 51 to 91 years old, (69 18) years old. Three lesions in 16 cases. Two lesions in 10 cases. One case of single-vessel disease. 10 cases of old myocardial infarction, diabetes, 9 cases. 19 cases of hypertension, 4 cases of renal dysfunction, 6 cases of old cerebral infarction. Cause of death: cardiogenic shock in 9 cases, 6 cases without recurrence, 2 cases of heart rupture, 2 cases of acute thrombosis, 2 cases of acute left heart failure, acute renal failure in 2 cases, 2 cases of intracranial hemorrhage, puncture bleeding 1 case of shock, 1 case of acute cardiac tamponade. Conclusion There are many causes of death in emergency interventional treatment of acute myocardial infarction. Cardiogenic shock and no-reflow are the main causes of death. Elderly, multi-vessel disease, diabetes mellitus, old myocardial infarction, etc. may be predictors of death.