经皮冠状动脉介入治疗后非梗死相关动脉处理对老年人急性心肌梗死预后的影响  

Impacts of treating stratege for non-infarct-related artery on clinical prognosis in elderly patients with acute myocardial infarction after urgent percutaneous coronary intervention

作　　者：黄宇 张鑫[2] 刘姗姗[2] 王璐 郜俊清 沈玲红[4] 李艳秋 陆纪德 林捷 葛智儒 张登海 邱建平 

机构地区：[1]上海浦东新区公利医院心内科,200135 [2]宁夏医科大学 [3]上海普陀区中心医院心内科 [4]上海交通大学医学院附属仁济医院心内科 [5]上海浦东新区公利医院急诊科 [6]上海浦东新区公利医院中心实验室

出　　处：《中华老年医学杂志》2012年第3期189-192,共4页Chinese Journal of Geriatrics

基　　金：基金项目：浦东新区社会发展局卫生科技重点合作项目（PW2009D-2）;上海市浦东新区卫生系统重点学科建设资助（PWZXK2010-05）

摘　　要：目的老年急性心肌梗死（AMI）多支血管病变急诊经皮冠状动脉（冠脉）介入治疗（PCI）后非梗死相关动脉采用药物或药物联合PCI治疗预后的比较。方法2007年8月至2011年8月年龄75岁以上AMI多支病变患者，接受PCI治疗75例，根据对非梗死相关动脉病变是否再次PCI将患者分为两组，其中PCI组30例，药物组45例。对比分析治疗平均1年后两组主要心血管事件发生率和冠脉造影结果的差异。结果随访终点行冠脉造影，药物组和PCI组急诊时行PCI治疗的梗死相关动脉支架内再狭窄[分别为1例（2．2％）和0例]、节段内晚期管腔丢失[5例（11．1％）和3例（10．0％）]、支架内血栓形成[1例（2．2％）和1例（3．3％）]、靶病变再次紧急血运重建[2例（4．4％）和1例（3．3％）]比较，差异无统计学意义（χ2值分别为0．00、0．00、2．03、0．00，均P〉0．05）。PCI组患者心绞痛复发率14例（46．7％）、再次因心原性疾病人院5例（16．7％），均低于药物组的36例（80．0％）、18例（40．0％），差异有统计学意义（χ2值分别为9．00，4．61，P〈0．01和P〈o．05）。继发性心力衰竭、再次非致命性心肌梗死、严重心律失常发生、全因死亡及心原性病死率比较，两组差异无统计学意义（χ2值分别为0．09、0．00、0．00、0．00、0．00，均P〉0．05）。结论老年AMI患者非梗死相关动脉血管采取PCI治疗较单纯药物治疗减少心绞痛复发率、再次因心原性疾病人院率。Objective To investigate the impacts of treating stratege for non-infarct-related artery on clinical prognosis in elderly patients with acute myocardial infarction （AMI） after urgent percutaneous coronary intervention （PCI）. Methods From Augst 2007 to Augst 2010, a total of 75 elderly AMI patients （aged 75 years and over） were treated by urgent PCI and confirmed as multivessel coronary disease in our hospital. Among them, 30 patients received medicine combined with PCI once again （PCI group） and 45 patients received only medicine treatemt （medicine group）. The major adverse cardiovascular events （MACE） and results of coronary angiography after treatment for average one year were compared between the two groups. Results There were no significant differences in the rates of in-stent restenosis[1 ease（2.2%）vs. 0 case], late loss of in-segment lumen [5 cases（11.1%）vs. 3 cases（10.0%）], stentthrombosis[1 case（2.2%）vs. 1 case（3.3%）1 and target vessel revascularization（2 cases（4.4%）vs. 1 case（3.3%）] between medicine group and PCI group （χ2 =0.00, 0.00, 2.03 and 0.00, all P〉0.05）. The propertions of angina recurrence and second hospital admission for heart diseases were lower in PCI group than in medicine group [36 cases （80.0%）vs. 14 cases（46.7%）,lScases（40.0G）vs. 5 cases（16.7%）, χ2=9.00, 4.61, P〈0.01and P%0. 051. However, no differences were found in the secondary heart failure, recurrent nonfatal myocardial infarction, severe arrhythmia, all-cause death and mortality rate of cardiovascular disease between the two groups （χ2 =0.09, 0.00, 0.00, 0.00 and 0.00, all P〈0.05）. Conclusions Compared with single medicine therapy, the medicine combined with PCI for non-infarct-related artery may decrease the rates of angina recurrence and second hospital admission for heart diseases in elderly patients with AMI.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 随访研究 

分 类 号：R542.22[医药卫生—心血管疾病]