冠状动脉3支供血区域心肌存活状态与冠状动脉旁路移植术后远期心脏事件的关系  

The relationship of myocardial viability of three coronary arterys dominated areas and the long-term adverse cardiovascular events following the coronary artery bypass graft

作　　者：姜睿[1] 胡盛寿[1] 田月琴[2] 何祚祥[2] 郑哲[1] 王巍[1] 

机构地区：[1]北京协和医学院阜外心血管病医院中国医学科学院心血管病研究所卫生部心血管疾病再生医学重点实验室心脏外科,北京100037 [2]北京协和医学院阜外心血管病医院中国医学科学院心血管病研究所核医学科

出　　处：《临床心血管病杂志》2009年第4期306-309,共4页Journal of Clinical Cardiology

基　　金：国家科技支撑计划项目(No:2006BAI01A09)

摘　　要：目的:探讨冠状动脉3支血管支配区域的存活心肌的情况与远期心血管不良事件之间的关系。方法:选自中国医学科学院阜外心血管病医院1999-01-01-2005-12-31行冠状动脉旁路移植术(CABG)(包括缺血所致二尖瓣的乳头肌功能不全需要同期行二尖瓣成形或置换术及室壁瘤手术),且术前进行了同位素SPECT存活心肌试验的冠心病患者。排除院内死亡患者后,共709例进入了本研究。术后定期对患者进行随访。调阅上述患者核医学资料,以心室17节段对术前心肌灌注和代谢(存活)情况进行半定量评分并进一步得出量化结果,在此基础上计算出冠状动脉左前降支、回旋支、右冠状动脉所支配区域的灌注和存活情况。并结合其他潜在危险因素,通过COX多因素分析的统计手段探寻心肌灌注、存活情况与事先选定的远期心脏不良事件(心因性死亡、再次入院以及复合终点事件)之间的关系。结果:平均随访时间为(3.43±2.42)年。COX多元分析表明:前降支支配区、回旋支支配区的存活心肌情况是远期心源性死亡、远期再入院的独立保护性因子;回旋支支配区域的心肌存活情况同时还是复合终点事件的独立保护性因子。结论:通过引入核医学中关于心肌存活的指标,结合其他相关因素,以左心室3支冠状动脉支配区域的同位素灌注/代谢的情况为着眼点,发现左心室前降支支配区、回旋支支配区域的存活心肌情况是影响远期预后的重要的独立相关因素。对于前壁部分心肌梗死的患者,注重前降支再血管化的同时,亦应充分重视回旋支的充分再血管化,这对于远期预后有重要意义。Objective：To explore the relationship between myocardial viability of three coronary arterys dominated areas and long-term cardiovascular adverse events. Method： Clinical data were selected from the coronaryheart-disease patients with CABG and the isotopic SPECT test of myocardial viability prior to the operation in the Fuwai Cardiovascular Hospital, the Chinese Academy of Medical Science from 1999-01-01- 2005 12-31 （in accordance with the date of surgery）. Total 709 patients were included in this study after removing the dead patients in the hospital. Regular follow up in patients was performed following operation. Investigate the nuclear medicine documents of the patients above, make the semiquantitative scores of myocardial perfusion and metabolism （sur rival） prior to operation by the 17-segment method of ventricle, and further obtain the quantified results, based on which calculation was carried out for the perfusion and survival in three coronary arterys dominated areas. In corn bination with other potential risk factors, through the COX multi-factor analysis of the statistical methods to ex plore the relationship between the myocardial perfusion and survival in three coronary arterys dominated areas and the long-term cardiac adverse events （cardiogenic death, readmission, and the combined end events） selected in advance. Result：The mean duration of follow-up was （3.43 ± 2.42） years. The COX multivariate analysis indicated that the myocardial viability in LAD and LCX dominated areas are independent protective factors of long-term ear diac death and re-admission; the myocardial viability in LCX dominated areas is also the independent protective factor of composite MACE. Conclusion：Through the myocardial viability index of the nuclear medicine, in combination with other related factors, it was found that the myocardial viability in LAD and LCX dominated areas were the important independent related factors influencing the long-term prognosis. With respect to the patients with myocardia

关 键 词：冠状动脉疾病 冠状动脉旁路移植术 存活心肌 心脏不良事件 预后 

分 类 号：R544.2[医药卫生—心血管疾病]