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目的:评价老年急性ST段抬高性心肌梗死病人,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人,进行补救性冠状动脉介入治疗的有效性、安全性及可能出现的特殊问题。方法:按照病人年龄分为≥70岁组(n=52)和<70岁组(n=67)2组,对于≥70岁组急性ST段抬高性心肌梗死病人,在急诊静脉溶栓治疗判定未能有效开通后,则即行冠状动脉造影,若造影显示梗死相关动脉血流为非心肌梗死溶栓治疗临床试验(TIMI)3级灌注、同时病人仍有较明显胸痛,和(或)梗死对应心电图导联ST段仍抬高,并除外急诊冠状动脉介入治疗的禁忌证,则即进行梗死相关冠状动脉的补救性介入再通治疗(包括球囊扩张、支架置入)。同时与<70岁组的ST段抬高性心肌梗死病人进行比较。结果:与<70岁组比较,≥70岁组在进行了静脉溶栓治疗后的急诊冠状动脉造影显示:溶栓有效开通比例低,同时在急性心肌梗死急性期的死亡绝对数较多;但梗死相关冠状动脉血管的介入治疗成功比例两组无差别,同时,在≥70岁组,接受了静脉溶栓治疗后,再行介入治疗的严重出血并发症(包括颅内出血、消化道大出血等)也未见显著增加。结论:≥70岁组急性心肌梗死病人,静脉溶栓有效开通比例较低,进行补救性冠状动脉介入成功比例与<70岁组相同,严密监测出、凝血参数,出现严重出血并发症低。
OBJECTIVE: To evaluate the efficacy, safety and potential of salvage coronary intervention in patients with acute ST-elevation myocardial infarction in the elderly after emergency thrombolysis Special problem Methods: According to the patient’s age, the patients were divided into two groups of ≥70 years old (n = 52) and <70 years old (n = 67) .All patients with ST-segment elevation myocardial infarction If the decision fails to be effective, then coronary angiography is performed. If angiography shows that infarction-related arterial blood flow is TIMI grade 3 perfusion, and the patient is still more likely to have chest pain and / or infarction Corresponding to the ST segment of the ECG lead is still elevated, and contraindications to emergency coronary intervention in the contraindication, then the infarct-related coronary artery remedial interventional re-treatment (including balloon dilatation, stent placement). At the same time with <70 years old group of ST-segment elevation myocardial infarction patients were compared. Results: Compared with patients under 70 years of age, emergency coronary angiography after ≥70 years of age undergoing intravenous thrombolytic therapy showed that the effective thrombolytic opening rate was low, while the absolute number of deaths in the acute phase of acute myocardial infarction was high. However, The success rate of interventional treatment of infarction-related coronary artery was no difference between the two groups. Meanwhile, serious bleeding complications (including intracranial hemorrhage, gastrointestinal bleeding, etc.) after interventional thrombolytic therapy in patients ≥70 years old, Also did not see a significant increase. Conclusions: The rate of successful thrombolysis in patients with acute myocardial infarction ≥70 years old is relatively low. The successful proportion of resuscitative coronary intervention is the same as that in patients <70 years old. Clotting parameters are closely monitored, and the complication rate of severe bleeding is low.