Analysis of mechanism in acute myocardial infarction with previous percutaneous coronary intervention / 中国介入心脏病学杂志

ABSTRACT

Objective To observe the characteristics of culprit lesions in AMI with previous PCI.Methods Retrospective analysis was carried out in 61 consecutive AMI patients with previous PCI treated with primary PCI from April, 2004 to April, 2006 in Fuwai hospital.Results Location of culprit lesions in the 61 patients (62.1?10.0 yrs; male 88.5%) were LAD 47.5%, RCA 39.5%, LCX 13.0%. Comparing the medication of the patients during the first year after the former PCI, besides the continous use of aspirin (93.8% vs 100%,P=0.113), all patients had stopped using clopidogrel, and the use of ?-blockers, ACEIs and statins also dropped significantly after 1 year (46.9% vs 75.0%, P= 0.001; 34.4% vs 70.8%, P= 0.001; and 28.1% vs 77.1%, P= 0.000, respectively). The characteristics of the culprit lesions included acute and sub-acute in-stent thrombosis in 12 cases (19.7%), late and very late in-stent thrombosis in 6 cases (9.8%), plaque rapture in 41 cases (70.5%), but no restenosis was involved. The time of the recurrant AMI after the former PCI were 13 cases (21.3%) within 1 month including 12 cases of acute or subacute in-stent thrombosis and 1 case of plaque rupture in anther coronary artery 3 days after primary PCI; 16 cases (26.2%) after the first month to 1 year including 12 cases of plaque rupture and 4 cases of late in-stent thrombosis; 32 cases (52.5%) 1 year including 30 cases of plaque rupture and 2 cases of very late in-stent thrombosis. Conclusion The major mechanism of recurrant AMI after preoious PCI is plaque rapture.