摘要目的 探讨直接经皮冠状动脉介入(PCI)治疗80岁以上急性心肌梗死(AMI)患者的临床疗效和安全性.方法 94例80岁以上AMI患者,入院后直接PCI.观察手术成功率、并发症、住院病死率和主要心脏不良事件,出院前测定左心室射血分数(LVEF).结果 冠状动脉造影示梗死相关血管(IRA)心肌梗死溶栓治疗(TIMI)m流分级0～1级,除2例心源性休克患者术中因室颤死亡,其余病例均成功开通IRA,操作成功率97.9%.术后76例血流TIMI 3级,16例TIMI 2级.术后6例因左心功能衰竭死亡.26例心功能Killip Ⅲ级以上者使用主动脉内球囊反搏(IABP)辅助循环,持续反搏时间78～154(98.3±34.5)h.多支病变者除18例3支病变外均在术后3～7 d行非IRA的PCI.住院总病死率8.5%(8/94),Killip Ⅲ级以上者病死率30.8%(8/26).仅3.3%(3/92)发生需输血的出血并发症.住院期间无主要心脏不良事件发生.生存的86例患者出院前测LVEF中位值为43%(26%～62%).存活者术后30 d和180 d主要心脏不良事件发生率分别为1.2%和4.6%.结论 对于80岁以上老年AMI患者行直接PCI安全可行,且成功率较高.

abstractsObjective To assess the clinical efficacy and safety of direct percutaneous coronary intervention (PCI) in patients over 80 years with acute myocardial infarction (AMI). Methods Direct PCI was performed in 94 patients over 80 years with AMI in our hospital. The operation success rate, complications, mortality, major adverse cardiac event and left ventricular ejection fraction (LVEF) were recorded during hospitalization. Results Coronary angiography showed thrombolysis in myocardial infarction (TIMI) 0-1 grade in infarct-related artery (IRA) before PCI. TIMI of coronary artery was grade 3 in 76 patients and grade 2 in 16 patients after PCI. Two patients with eardiogenic shock died from ventricular fibrillation during PCI, and IRA was successfully reeanalizated in other 92 patients. The operation success rate of PCI was 97.9%. Six patients died from left heart failure postoperation. Intra-aortic balloon pump was performed to assist circulation in 26 patients with Killip Ⅲ, and the duration of counterpulsation was 78 to 154(98.3±34.5)h. Patients with multiple IRAs except 18 patients with 3 IRAs were received non-IRAs PCI 3 to 7 d after the operation. The fatality during hospitalization was 8.5% (8/94) in general, and the mortality of in-patients with heart function no less than Killip Ⅲ was 30.8%. The rate of bleeding complication needed blood transfusion was 3.3% (3/92). There was no major adverse cardiac event in survival patients during hospitalization. The rates of major adverse cardiac events at 30 and 180 d were 1.2% and 4.6%. The median LVEF was 43% (26% to 62% ) before discharge. Conclusion Direct PCI is a safe operation with high successful rate for patients over 80 years with AMI.