急性ST段抬高心肌梗死合并非梗死相关动脉慢性完全闭塞直接PCI预后观察  

The outcome of primary PCI in patients with ST-elevation myocardial infarction combined chronic total occlusion of non-infarction-relative artery

作　　者：潘洪涛[1] 高鹏[1] 王旭渤[1] 刘忠岐[2] 

机构地区：[1]吉林大学第四医院心血管内科,长春市130011 [2]吉林大学第四医院放射科,长春市130011

出　　处：《中国临床研究》2011年第11期972-974,共3页Chinese Journal of Clinical Research

摘　　要：目的分析急性ST段抬高心肌梗死(STEMI)合并非梗死相关动脉(non-IRA)慢性完全闭塞(CTO)患者临床特点和急诊经皮冠状动脉介入治疗(PCI)预后。方法 417例STEMI接受直接PCI患者中,53例至少1支non-IRA为CTO(A组),另364例无non-IRA CTO(B组),比较2组病史、介入治疗及其预后。结果 A组陈旧性心肌梗死病史比率(9.4%vs 2.5%,P<0.05)、2型糖尿病病史比率(26.4%vs 12.9%,P<0.05)、应用主动脉内球囊反搏(IABP)率(17.0%vs 8.0%,P<0.05)、临时起搏率(20.8%vs 7.4%,P<0.01)、心脏电复律率(26.4%vs 7.1%,P<0.01)均高于B组;随访期间(至少12个月),A组因心功能不全再次住院率高于B组(28.3%vs 12.9%,P<0.05);2组急性期住院期间病死率分别为3.8%和3.6%,随访期间病死率分别为5.7%和5.5%,2组比较差异均无统计学意义(P均>0.05)。结论 STEMI合并non-IRA CTO患者既往糖尿病、心肌梗死病史多见,病情凶险,借助IABP、心脏电复律、临时起搏治疗多见,但直接PCI仍可明显提高生存率,改善近期、远期预后。Objective To analyze clinical features of ST-elevation myocardial infarction （STEMI）combined chronic total occlusion （CTO）of non-infarction-relative artery （non-IRA） and the prognosis of primary pereutaneous trasluminal coro- nary intervention （PCI）. Methods A total of 417 patients with STEMI within 12 hours of onset admitted from June 2007 to June 2010 were recruited. The patients were divided into two groups according to with or without CTO of non-IRA：A group （53 cases） with CTO of one branch of non-IRA at least and B group （364 cases） without CTO of non-IRA. The case history,the condition of PCI therapy and the outcome were compared. Results Compared with B group,the ratios of medical history including old myocardial infarction and diabetes type 2 （9.4% vs 2.5% ,26.4% vs 12.9%, all P 〈 0. 05 ）, the ratio of using intra- aortic balloon counterpulsation （IABP） （ 17.0% vs 8.0% ,P 〈 0. 05 ）, the ratio of using temporary pacing （20.8% vs 7.4%, P 〈0.01 ） ,the ratio of using cardiac electrical conversion （26.4% vs 7.1% ,P 〈0. 01 ） were higher in group A. At follow-up period of 12 months at least, the rate of re-hospitalization due to hart failure in group A was higher than that in group B （28. 3% vs 12.9% ,P 〈0. 05）. There were no significant differences for in-hospital mortality of acute period and the mortality of follow-up period between A and B groups （ 3.8% vs 3.6% ,5.7% vs 5.5 %, all P 〉 0.05 ）. Condusions In patients with STEMI combined CTO of non-IRA ,the anamnesis of diabetes and myocardial infarction is common, and Patient＇s condition is dangerous ;Therapies with IABP, cardiac electrical conversion and temporary pacing are common, but primary PCI could still raise survival rate and improve short-term and long-term prognosis.

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 非梗死相关动脉 慢性完全闭塞 

分 类 号：R542.2[医药卫生—心血管疾病]