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Kokyu to Junkan Volume 45, Issue 8 （August 1997）

呼吸と循環 45巻8号（1997年8月発行）

Japanese English

研究

高齢者急性心筋梗塞に対する冠動脈内血栓溶解療法の有用性とその限界 Efficacy and Limitation of Intracoronarv Thrombolysis for Acute Myocardial Infarction in Eldery Patients Older than 70 Years of Age:Comparison of younger patients younger than 65 years in our hospital 田部井史子 ¹ , 飯田要 ¹ , 榎本強志 ¹ , 斎藤巧 ¹ , 外山昌弘 ¹ , 小関迪 ¹ , 渡辺重行 ² , 富沢巧治 ² , 山口巌 ² , 杉下靖郎 ² Fumiko Tabei ¹ , Kaname Iida ¹ , Tsuyoshi Enomoto ¹ , Takumi Saito ¹ , Masahiro Toyama ¹ , Susumu Koseki ¹ , Shigeyuki Watanabe ² , Takuji Tomizawa ² , Iwao Yamaguchi ² , yasuro Sugishita ² ¹筑波記念病院循環器内科 ²筑波大学臨床医学系内科 ¹Department of Cardiology, Tsukuba Memorial Hospital ²Cardiovascular Division, Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba キーワード：高齢者 , 急性心筋梗塞 , 冠動脈内注入血栓溶解療法 , elderly patients , acute myocardial infarction , intracoronary thrombolysis Keyword: 高齢者 , 急性心筋梗塞 , 冠動脈内注入血栓溶解療法 , elderly patients , acute myocardial infarction , intracoronary thrombolysis pp.795-800

発行日 1997年8月15日 Published Date 1997/8/15

DOI https://doi.org/10.11477/mf.1404900049

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Abstract 文献概要
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　当施設に入院した70歳以上の高齢者急性心筋梗塞（AMI）14例（E群）と65歳以下の非高齢者AMI 52例（Y群）に対し冠動脈内注入血栓溶解療法（ICT）を施行し，その有用性を検討した．再疎通成功率にE群とY群で有意差を認めず（TIMI II≦：79％vs88％，III：50％vs52％），投与前の問診によって出血などの危険性の少ないことを判断したため合併症は僅少であった．陳旧性心筋梗塞の既往，発症からICTまでの時間，責任病変部位，重症度，最大CPK値，慢性期の責任病変狭窄度，慢性期左室駆出分画に両群間で有意差を認めなかったが，責任病変を含めた多枝病変をE群がY群より多く有していた（2VD≦：72％vs46％，3VD：36％vs13％）．E群の院内死亡率はY群より有意に高値（36％vs4％，p＜0.02）であった．以上よりE群へのICTは再疎通率に関してはY群と同等で有用であったが．ICT後の残存狭窄が高度で院内死亡率が高値であった．

In 14 elderly patients older than 70 years of age and 52 younger patients younger than 65 years with acute myocardial infarction (AMI), effect of intracoronary thrombolysis (ICT) in our hospital were evaluated. The intracoronary thrombolysis for elderly patients had good effect on coronary recanalization to compare favorably with younger patients (TIMI G-2 or 3: 79% vs 88%, G-3: 50% vs 52%). And hemorrhagic compli-cations after treatment of AMI with ICT were little. because we performed ICT for patients in the absence of contraindications to thrombolytic or anticoagulant ther-apy and informed consent from the patient after approval by the patient's physician. Time from onset of AMI to start ICT, location of target lesion, severity of coronary stenosis, value of peak creatine kinase, coro-nary stenosis and left ventricular function of chronic stage did not differ significantly between the two age groups. But the elderly had a greater prevalence of multiple-vessel coronary artery disease (2 or 3VD: 72% vs 46%). Residual stenosis of chronic stage significantly increased with age. In-hospital mortality was 36% for elderly patients, compared with 4% in younger patients (p＜0.02). The couses of increased in-hospital mortality rate were severe coronary stenosis and multiple-vessel disease in elderly patients. Elective percutaneous transluminal coronary angioplasty (PTCA) were performed in 43% of elderly patients, and the effect of PTCA demonstrated benign prognosis.