合并慢性完全闭塞病变的急性心肌梗死患者住院期间预后分析  

Prognosis analysis of patients with acute cardiac infarction combined with chronic total occlusion during hospitalization

作　　者：刘鸣[1] 钱菊英[1] 刘学波[1] 葛雷[1] 张峰[1] 张少衡[1] 王翔飞[1] 王齐兵[1] 樊冰[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海200032

出　　处：《上海医学》2008年第11期792-795,共4页Shanghai Medical Journal

基　　金：国家973项目(2006CB503803;2005CB523302);国家863项目(2006AA02A406)

摘　　要：目的探讨非梗死相关血管合并慢性完全闭塞病变(CTO)是否增加冠状动脉多支病变的急性心肌梗死患者住院期间风险,及风险是来源于CTO病变自身抑或是同时存在的其他危险因素。方法回顾性分析2005年9月-2007年12月期间连续入院接受急诊经皮冠状动脉介入治疗(PCI)合并冠状动脉多支病变的ST段抬高心肌梗死(STEMI)患者。比较合并及不合并CTO病变的冠状动脉多支病变患者的临床及急诊介入手术资料,采用Logistic回归进行多因素分析,确定发生住院期间主要心脏不良事件(MACE)的独立危险因素。结果接受急诊PCI的冠状动脉多支病变STEMI患者185例,其中合并CTO病变(CTO)组20例(10.8%)。住院期间,CTO组的冠状动脉三支病变发生率为65.0%,显著高于无合并CTO病变(无CTO)组的37.6%(P=0.02);急诊PCI术后梗死相关血管恢复心机梗死溶栓试验(TIMI)血流3级的构成比为85.0%,显著低于无CTO组的93.3%(P=0.01);左心室射血分数(LVEF)为0.511±0.120,显著低于无CTO组的0.582±0.995(P=0.02);MACE发生率为30.0%,显著高于无CTO组的10.9%(P=0.02)。CTO病变不是冠状动脉多支病变患者发生住院期间MACE的独立危险因素。结论合并CTO病变的STEMI患者的冠状动脉病变更为广泛及严重,急诊PCI术后发生无复流的风险增加,因此导致住院期间发生MACE的风险增大,但它不是影响短期预后的独立危险因素。此外,合并CTO病变患者的左心室功能明显减低,提示长期预后不良。Objective To investigate whether chronic total occlusion（CTO） can increase the in-hospital risks of patients with multi-vessel disease undergoing primary percutaneous intervention for ST-elevation myocardial infarction （STEMI）, and whether the risk is due to CTO itself or due to other resources. Methods The clinical data of consecutive STEMI patients with multi-vessel disease undergoing primary stenting in our hospital from September, 2005 to December, 2007 were retrospectively analyzed. Clinical and angiographic characteristics were compared among patients with or without CTO lesion. The multivariate analysis was applied to identify the independent risk factors of adverse in-hospital outcome. Results A total of 185 patients undergoing percutaneous intervention were included in this study. Twenty patients （10.8%） were identified with CTO in the non-infarct related artery and they had a higher incidence of triple-vessel disease （65.0% vs. 37.6% ,P=0.02）, lower rate of procedural success（85.0% vs. 93.3% ,P=0.01）, and in-hospital major adverse cardiac events （MACE, 30.0% vs. 10.90%,P=0.02）. Multivariate analysis showed that the presence of CTO lesion was not an independent predictor of in-hospital MACE. Conclusion Patients with CTO lesion are associated with higher incidence of disseminated coronary disease and no reflow, which puts them at an increased risk of developing in-hospital MACE. Furthermore, left ventricular function is impaired in patients complicated with CTO, implying a poor long-term prognosis.

关 键 词：ST段抬高心肌梗死 急诊介入治疗 慢性闭塞病变 住院期间预后 

分 类 号：R542.22[医药卫生—心血管疾病]