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Objective To compare the effect of different perfusion methods on early outcomes of elderly patients with acute myocardial infarction.Methods The clinical data of 110 cases including EKG,echocardiogram and angiography were retrospectively analyzed.Of these patients,45 cases were treated by primary percutaneous coronary intervention (PCI),30 cases by intravenous thrombolysis,and 35 cases by PCI combined with intravenous thrombolysis therapy.The incidence rate of cardiovascular events during hospitalization,no reflow incidence,average hospitalized staying time,left heart function and Killip cardiac function grade at 3 months were compared between the three groups.Results There was no significant difference on incidence rate of cardiovascular events between the three groups (P ＞ 0.05).Compared with PCI group and intravenous thrombolysis group,the combination group had lower no reflow incidence,less hospital time and lower Killip cardiac function grade (P ＜ 0.05).In addition,the parameters of LVEF,CI and SVI of combination group were significantly higher than other groups after 3 months (P ＜ 0.05).Conclusion PCI combined with intravenous thrombolysis was safe and effective in treatment of elderly STEMI patients,which could obviously decrease the no reflow rate,improve cardiac function and the early outcomes.
RESUMO
Objetivo - A análise da experiência com a utilizaçäo da angioplastia coronária primária no infarto agudo do miocárdio em pacientes acima de 70 anos, sem o uso prévio de agentes, trombolíticos. Métodos - Quarenta e dois pacientes com diagnóstico de infarto agudo do miocárdio foram submetidos à angioplastia transluminal coronária nas primeiras 12 horas de evoluçäo do episódio agudo dos quais 47% nas 3 horas iniciais de apresentaçäo. As idades variaram de 70 a 86 (m = 76,4) anos; 54,7% eram do sexo masculino e 43% exibiam infarto da parede anterior do ventrículo esquerdo. A angioplastia coronária foi realizada apenas para a artéria responsável pelo evento agudo; a descendente anterior foi tratada em 43% dos pacientes, a coronária direita em 47% e a circunflexa em 10%. Oitenta e um por cento dos casos encontravam-se nas classes funcionais I e II de Killip e os demais nas classes III e IV. Resultados - Sucesso primário foi de 86%. A mortalidade hospitalar ocorreu em 14,2% dos pacientes, sendo significativamente superior nos pacientes do sexo feminino (26,3%), naqueles na classificaçäo de Killip III e IV (37,5%), nos portadores de doença coronária multiarterial (16,6%) e nos casos com insucesso da angioplastia coronária (33%). Ocorreram 8,3% de reinfartos e nenhuma complicaçäo hemorrágica de maior porte. O reestudo angiográfico foi realizado em 50% dos pacientes revelando 72% de permeabilidade arterial tardia com melhora significativa da fraçäo de ejeçäo global e regional, principalmente nos que mantiveram o resultado inicial do procedimento. Conclusäo - A angioplastia coronária primária, sem o uso prévio de agentes trombolíticos, quando empregada em pacientes idosos e infartados, exibe alto percentual de sucesso, baixa taxa de mortalidade e ausência de fenômenos hemorrágicos graves
Purpose - To evaluate the use of primary coronary angioplasty (PTCA) in patients older than 70 years, evolving with acute myocardial infarction, without the previous administration of thrombolitic agents. Methods - Forty-two patients with acute myocardial infarction (AMI) and more than 70 years of age (m = 76.4y). There were 54.7% men and 43% of them had anterior MI. PTCA was carried out during the first 12 hours of evolution and in the first 3 hours of duration in 47% of them. PTCA was done only to the AMI related artery, which was the left descending artery in 43%, the right coronary artery in 47% and the left circunflex in the remaining patients. Nineteen percent of these patients were in Killip class III e IV. Results - Primary success was achieved in 86%. The in hospital mortality was 14.2%, and it was superior in female gender (26,3%), in Killip class III and IV (37.5%), in those with multivessel coronary disease (16.6%) and in those where primary PTCA failed (33%). There were 9.3% of reinfarction, but no major hemorrhagies happened. Late angiography was done in 50% of patients, showing 72% of patency in the AMI related artery, and a significant improval of global ejection fraction and of the wall motion, particularly, in those who maintained arterial patency. Conclusion - Primary PTCA, without former use of thrombolytic agents, when applied early in elderly patients evolving with AMI, has a high success rate and low mortality rate in this subset of high risk patients. It also shows no major hemorrhagic complications