Diagnosis and treatment experience of acute ST-segement elevation myocardial infarction with simultaneousocclusion of double coronary arteries
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摘要: 本研究主要探讨2支冠状动脉同时急性闭塞的急性ST段抬高型心肌梗死的诊治要点。回顾性分析2016年11月-2017年12月我院连续诊治的3例前降支和右冠同时急性闭塞患者的诊治经过,总结其临床症状、心电图表现、造影特点和急诊PCI手术策略与预后关系。第1例患者先处理右冠,后处理前降支,前降支支架后出现致死性无复流;第2例患者先处理右冠,出现致死性再灌注性心律失常;第3例患者先处理前降支,后处理右冠,没有出现并发症,1年随访无心脏主要不良事件。前降支和右冠同时急性闭塞的急性ST段抬高型心肌梗死,避免先处理更容易出现严重再灌注损伤反应的右冠,有可能提高成功率。
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关键词:
- 急性ST段抬高型心肌梗死 /
- 急性闭塞 /
- 冠状动脉
Abstract: To explore the treatment of the acute ST-segement elevation myocardial infarction with simultaneous occlusion of double coronary arteries.A cohort of 3 consecutive patients with acute simultaneous occlusion of double coronary arteries admitted from November 2016 to December 2017 were enrolled in the study.The relationship between the prognosis and clinical data,the EKG,the findings of coronary artery angiography and the strategy of the emergency primary percutaneous coronary intervention were explored.For the first patient,the right coronary artery(RCA) was treated first and then the left anterior descending coronary artery(LAD) was treated later,and deadly no-flow happened during the stenting in LAD.For the second patient,RCA was also treated first,and deadly reperfusion arrhythmia happened.In contrast,for the third patient,the LAD was treated first and then RCA,but no complication was observed and there were no major adverse cardiac events at 1 year follow-up.It is maybe possible to increase the success rate by avoiding the priority to treating the coronary arteries that are prone to severe reperfusion injury in the patients with acute myocardial infarction with acute simultaneous occlusion of both LAD and RCA. -
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