STEMI急诊PCI后多支冠脉病变治疗的评价  

Clinical study of different treatment strategy for AMI patients treated by primary PCI with multi-vessel coronary artery disease

作　　者：陆民[1] 姚成立[1] 沙勇[2] 贾绍斌[2] 魏宁[2] 仇玉民[2] 薛朝阳[1] 王晖[3] 张宁[1] 

机构地区：[1]宁夏银川市第一人民医院,宁夏银川750001 [2]宁夏医科大学附属医院,宁夏银川750001 [3]江苏省人民医院,江苏南京210000

出　　处：《宁夏医学杂志》2009年第7期600-602,共3页Ningxia Medical Journal

基　　金：宁夏自然科学基金资助项目(NZ07112);宁夏卫生厅重点科研计划课题(W200733)

摘　　要：目的对ST段抬高急性心肌梗死(STEMI)伴多支冠状动脉病变的患者,急诊经皮冠状动脉介入(PCI)后,比较药物治疗或择期PCI处理非梗塞相关血管的临床疗效,评估STEMI后对非梗塞相关血管的最佳处理方法。方法分析比较了151例伴多支冠状动脉病变行急诊PCI处理梗塞血管的STEMI患者,根据对非梗塞相关血管不同处理方式分为两组,组1为心梗后7-14d行择期PCI者共64例,组2为药物治疗者共87例。比较两组病情变化、造影资料、住院期间及远期严重心血管不良事件(MACE)的发生情况。结果两组临床情况及造影结果相似;组1病人的住院日为(16.98±5.84)d,较组2病人(11.29±5.00)d长,二者比较P=0.000;院内MACE发生率在组1为4.69%、组2为4.60%,院外MACE发生率在组1为3.13%、组2为13.79%,二者比较院内MACE差异无统计学意义,随访MACE差异有统计学意义(P=0.026)。结论STEMI伴多支冠脉病变患者急诊PCI后,再择期行PCI术,远期MACE发生率低于药物治疗。Objective To observe the clinical outcome of patients with acute myocardial infartian（AMI） and muhivessel coronary disease（MVD） undergoing primary percuteneous coronary intervention（PCI） ,whether staged PCI or drug therapy. Evaluate optima] treatment strategy of non - culprit vessels. Methods Data of 151 patients with STEMI and MVD treated by primary PCI were analyzed. Patients were divided into 2 groups , Group 1 （ n = 64） with staged PCI of non - culprit vessels after primary PCI 7 - 14days, Group 2 （ n = 87） with drug therpy. Comparing clinical and coronary angiographic data, in - hospital and long - term major adverse cardiovascular events （MACE）. Results Clinical and angiographic data are similar between two groups. In Group 1 more hospital stay（ 16.98 ± 5.84 days） than Group 2（ 11.29±5.00） （P =0.000）. Group 1 patients underwent staged PCI 7.9 ±6.0 days after primary PCI. The mean length of follow - up was 14 months （433.3 ±325.9days）. The incidence of in - hospital MACE was 4.69% in Group 1 and 4.60% in Group 2 （P=1.0） ;the incidence of follow-up MACE was3.13% in Group 1 and 13.79% in Group 2（P=0.026）. Conclusions Our data show that staged PCI in STEMI patients with MVD underwent primary PCI is associated with a low incidence of MACE at follow - up.

关 键 词：急性心肌梗死 多支冠脉病变 经皮冠状动脉介入 

分 类 号：R542.22[医药卫生—心血管疾病]