PTCR後の緊急ACバイパス手術及び緊急PTCAの適応についての検討

Indication of emergency coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) subsequent to percutaneous transluminal coronary recanalization

　PTCRにより梗塞責任領域の冠動脈の再疎通を得ることは，患者を救命し良好な予後を得る上で重要であると一般に認識されてきた^1〜3）。しかし，それにひき続く冠動脈再建手術CABG（以下同）及びPTCAの適応については現在のところはっきりとしたコンセンサスは得られていない。今回我々はPTCR （以下同）後の緊急CABG症例，緊急PTCA症例，及び保存療法例について検討し考察を行ったので報告する。

We performed ICT in 56 patients with MI within six hours after onset. Of these cases, ten cases of multiple vessel disease were undergone CABG and three cases of single vessel disease were undergone PTCA immediately after reperfusion by ICT beca-use of low flow with filling delay of dye (Group A). Seven cases with cardiogenic shock were under-gone emergency CABG after successful or unsucces-sful ICT (Group E.) 16 ICT successful cases with-out filling delay of dye (Group B) and 8 successful cases with filling delay (Group C) and 12 unsucces-sful cases (Group D) were treated conservatively.

These results showed that clinical data and the effect on salvage of jeopardized myocardium of A group and B group (especially within 4 hours) are significantly better than that of Cand D group, and that results of elective CABG and PTCA in B group are good.

In the E group, 2 cases were saved, however, 5 cases died. And then emergency CABG after ICT of the case with cardiogenic shock must be consi-dered carefully.

In conclusion, emergency CABG or PTCA is neccesary for case with filling delay of dye after reperfusion by ICT, and, in contrast, emergency CABG or PTCA is not neccesary for case without filling delay of dye after reperfusion by ITC.