目的研究分析冠状动脉内支架置入术治疗冠心病心肌梗塞和不稳定心绞痛的安全性和有效性。方法回顾性分析本院2001年1月至2005年5月经皮冠状动脉支架植入术治疗142例冠心病心肌梗塞和不稳定心绞痛患者临床资料,随访评价其近、中期临床疗效和安全性。结果共处理病变血管162支,其中前降支病变79例,回旋支病变24例,右冠脉病变54例,第一钝缘支病变3例,第一对角支病变1例,中间支病变1例,血管平均狭窄程度(92.51±9.05)%,经股动脉途径110例,经桡动脉途径32例,植入支架179个,植入支架的总成功率97.2%,支架平均长度为21.38±5.08 mm,支架的平均直径3.04±0.35 mm,支架释放压力平均为12.55±1.74atm,平均住院天数21.88±11.92 d。主要并发症:死亡3例,发生心肌梗死1例,急性冠脉搭桥1例,术中出现室速、室颤6例,均除颤成功。随访3月~2年,支架植入术后因心脏事件再次住院患者30例(占21.1%),支架内再狭窄8例,均为Medtronic AVE系列裸支架,支架内再狭窄率4.5%,其余患者临床疗效均佳,无心脏事件及心绞痛发生,生活质量较好。结论本组资料显示,冠脉内支架置入术治疗包括复杂病变在内的冠心病心肌梗塞和不稳定心绞痛成功率高,并发症低,疗效确切,是治疗冠脉病变尤其是处理PTCA术中明显内膜撕裂和急性血管闭塞的有效方法。 Objective To study the safety and efficacy of intracoronary stenting in the treatment of myocardial infarction and unstable angina pectoris. Methods The clinical data of 142 patients with coronary heart disease with myocardial infarction and unstable angina pectoris treated by percutaneous coronary stent implantation from January 2001 to May 2005 in our hospital were retrospectively analyzed. The clinical efficacy and safety were evaluated at follow-up. Results A total of 162 vascular lesions were treated, including 79 cases of anterior descending coronary artery disease, 24 cases of circumflex artery lesions, 54 cases of right coronary artery disease, 3 cases of first obturator limbal branch disease, 1 case of diagonal branch disease, 1 case, mean vessel stenosis (92.51 ± 9.05)%, 110 cases via femoral artery and 32 cases via transradial approach. The total number of stent implantation was 179.2%, and the average stent length was 21.38 ± 5.08 mm, the average diameter of stent was 3.04 ± 0.35 mm, the average stent release pressure was 12.55 ± 1.74atm, and the average length of stay was 21.88 ± 11.92 days. The main complications were: death in 3 cases, myocardial infarction in 1 case, acute coronary artery bypass graft in 1 case, intraoperative ventricular tachycardia, ventricular fibrillation in 6 cases, both defibrillation success. All cases were followed up for 3 months to 2 years. Thirty patients (21.1%) were hospitalized again for cardiac events after stenting, and 8 were in-stent restenosis. All patients were treated with Medtronic AVE series bare stent and stent restenosis rate 4.5% Patients with good clinical efficacy, no cardiac events and angina, better quality of life. Conclusion The data in this group show that coronary stenting has a high success rate of myocardial infarction and unstable angina pectoris, including complicated lesions. Complication rate is low and the curative effect is definite. It is an effective way to treat coronary artery disease, especially in PTCA An obvious method of intima tear and acute vascular occlusion.