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題 名 | Primary Coronary Angioplasty for Treatment of Patients with High Risk Acute Myocardial Infarction--Is It Feasible Therapeutic Modality?=直接經皮冠狀動脈擴張術治療高危險群急性心肌梗塞--是否為一可行之治療方式? |
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作 者 | 羅鴻舜; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 13:1 民86.01-03 |
頁 次 | 頁1-11 |
分類號 | 415.3161 |
關鍵詞 | 直接經皮冠狀動脈擴張術; 急性心肌梗塞; 高危險群; Primary angioplasty; Acute myocardial infarction; High risk group; |
語 文 | 英文(English) |
中文摘要 | 背景:以直接經皮冠狀動脈擴張術(PTCA)治療急性心肌梗塞乃是眾所周知的治療方式。本篇的目的在於評估:直接性PTCA是否能夠有效地治療急性心肌梗塞病患,即使是高危險群者。 方法:自1994年1月至1996年10月共270位急性心肌梗塞病患,我們收集了76位接受直接PTCA的病患,並將之分成兩組。凡是含有下列因素兩項或以上者稱為高危險群(28例):(年紀在70歲以上,射血分率< 45%,3條血管病變,惡性心室性不整脈,血壓過低或休克,植入靜脈阻塞)。而不是上述者稱之為低危險群(48例)。 結果:在76位接受直接PTCA病患中,手術成功有72例(94.7%)。住院中,發生心絞痛者5例(6.6%),其中2例接受繞道手術(2.6%),4例需要主動脈內氣球幫浦來支持(5.3%),住院中死亡者6例(7.9%)。比較低危險群者,高危險群似乎具有較多心衰竭(28.6% vs 6.3%,P=0.008),較需要主動脈內氣球幫浦來支持(14.3% vs. 0%, P=0.008),較長的住院天數(9.5 ± 4.5 天 vs. 7.6 ± 2.0天P=0.136)。至於住院中:手術成功率(89.3% vs. 97.9%,NS),死亡率(10.7 % vs. 6.3%,NS),緊急繞道手術(7.9% vs. 0%,NS),再度心絞痛╱心肌梗塞(3.6% vs. 8.3%,NS及0% vs. 0%,NS)則圴無統計學上之差異。出院後,76位中有64例接受2至34個月(平均13.5 ± 9.6月)追蹤,其中心紋痛再患者有06例(25.0%)2例心肌梗塞(3.1%)重作PTCA有8例(12.5%),繞道手術2例(3.1%),1例死於非心臟因素(1.6%)。比較低危險群,高危險群並沒有較多的復發性心絞痛(13% vs 31.7%,NS)、心肌梗塞(0% vs. 4.9%,NS),及需要再做PTCA (4.3% vs 17.1%,NS)、繞道手術(4.3% vs. 2.4%,NS)之機率。 結論:在有限的經驗中,我們發現:病人來到一間設備完善,同時具有豐富經驗的介入性心臟科醫師之全天侯待命,及心臟外科醫師之奧援,則直接 PTCA 確實能迅速而完全地打通梗塞有關的血管,從而改善住院中以及出院後的臨床過程。如此,對屬高危險群心肌梗塞病患施以直接 PTCA,其改善病人所獲得之益處,將大可抵銷此時手術所存在的危險性。當然,這些觀察仍需更大規模、隨意挑選之對照研究來加以證實。 |
英文摘要 | Background.Primary percutaneous transluminal coronary angioplasty (PTCA) used to treat patients with acute myocardial infarction (AMI) is a well-known therapeutic modality. The purpose of this study was to assess if primary PTCA could effectively treat patients with AMI, even at high risk. Methods. Between January 1994 and October 1996, of 270 AMI patients, 76 were assigned to undergo primary PTCA. High risk group consisted of 28 patients and had ≦ 2 high risk factors (i.e., age > 70 years, ejection fraction (EF) < 45%, 3-vessel disease, malignant ventricular arrhythmia, hypotension or shock, or vein graft occlusion). The low risk group consisted of 48 patients who were not at high risk. Results. Primary PTC was performed in 76 patients, with a procedural success for 72 (94.7%). Five patients (6.6%) had recurrent angina; two of them were assigned to bypass surgery. Four patients (5.3%) needed intraaortic balloon pumping (IABP) for hemodynamic support. The in-hospital mortality was six (7.9%) . Compared to the low risk group, the risk group tended to have more chance of left ventricular (LV) failure (28.6% vs. 6.3%, p=0.008), ore emergency bypass surgery (7.1% vs. 0%, p=0.064), were more needful of IABP support (14.3% vs. 0%, p=0.008) and had a longer hospital stay (9.5 ± 9.6)months. sixteen patients had recurrent angina (25.0%) and two infarction (3.1%). Repeat PTCA was performed in eight (12.5%), bypass surgery in two (3.1%). One (1.6%) died of a non-cardiac cause. As for recurrent angina (13.0% vs. 31.7%, NS), reinfarction (0% vs. 4.9%, NS), repeat PTCA (4.3% vs. 17.1%, NS), or CABG (4.3% vs. 2.4%, NS), they were not significantly different. Conclusions. From this limited experience, primary PTCA was found to rapidly and completely open an infarct-related artery thus improving the in-hospital, and also long-term clinical outcome, at those facilities which were suitably equipped and fully staffed by skilled interventional cardiologists ad had cradiovascular surgery back-up. The study also suggested that the benefits from primary PTCA outweighed the complications associated with the procedure for patients with AMI, especially those at high risk. However, large-scale, randomized controlled trials shoud be further conducted. |
本系統中英文摘要資訊取自各篇刊載內容。