急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗同时处理非梗死相关血管的疗效研究  

Effects and safety of primary percutaneous coronary intervention for both infarct and non-infarctrelated artery in patients with acute ST-segment elevation myocardial infarction and multivessel disease

作　　者：张晓锋[1] 刘艳[1] 惠玲玲[1] 吕强[1] 邵玉玲[1] 樊沫 

机构地区：[1]西安交通大学医学院附属西安高新医院心内科,710075

出　　处：《中国心血管杂志》2015年第3期171-175,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)同时处理存在严重狭窄的非梗死相关血管的安全性及1年随访期的疗效。方法将221例多支血管严重狭窄的急性STEMI患者,根据急诊PCI是否处理非梗死相关血管分为常规组(仅处理罪犯血管)179例及处理组(同时处理非梗死相关血管)42例,观察两组的住院时间、术后心绞痛症状、心功能状况、再次手术率、再次住院率、主要不良心血管事件(MACE,包括术后及随访期间心原性死亡、非致死性再次心肌梗死)发生率等的差异。结果两组患者在年龄、性别、体质指数、低密度脂蛋白胆固醇、血糖、血肌酐、吸烟史、糖尿病、高血压、发病至球囊扩张时间等方面,差异均无统计学意义(均为P>0.05)。与常规组比较,术后处理组的心绞痛发生率降低(40.48%比60.34%,χ2=5.46,P=0.02)、再次手术率降低(9.52%比58.10%,χ2=32.13,P=0.00)和再次住院率减低(11.90%比27.93%,χ2=4.68,P=0.03)。处理组心功能状况优于常规组[(1.19±0.59)级比(1.49±0.89)级,t=2.66,P=0.01]。两组MACE发生率差异无统计学意义(4.76%比2.79%,χ2=0.03,P=0.87)。结论急性STEMI直接PCI同时处理存在严重狭窄的非梗死相关血管有助于减少心绞痛发作,降低再次手术率、再次住院率,改善心功能状况,且未增加MACE发生率,在预期成功率高的情况下可作为急性STEMI直接PCI的一种选择。Objective The purpose of this study was to investigate the feasibility and safety of treatment for both infarct and non-infarct-related artery in patients with acute ST-segment elevation myocardial infarction（ STEMI） and multivessel disease（ MVD） during primary percutaneous coronary intervention（ PCI） procedure and its effectiveness in the one year follow-up period. Methods A total of 221 eligible patients with acute STEMI and at least with two major diseased coronary arteries（ luminal stenosis≥75%） underwent primary PCI were included,the mean age was 57. 9 ± 12. 0（ 32-82） years old. Of them,179 patients underwent primary PCI for infarct-related artery（ IRA） only（ group routine）,and 42 patients received primary PCI for non-IRA at the same time of IRA were treated successfully（ group treatment）.Drug-eluting stent（ DES） were used in all the patients. Then to compare the differences of the time of hospital,symptom of angina pectoris after the primary PCI, the rates of re-revascularization and the readmission,cardiac function in the follow-up period and the major adverse cardiac events（ MACE,such as death of cardiac,nonfatal reinfarction） between the two groups. Results There were no differences in clinical characteristics（ such as age,sex,body mass index,LDL-C,blood glucose,serum creatinine,the history of smoking,diabetes mellitus and hypertension,the time from symptom emerge to balloon dilatation）between the two groups（ P〉0. 05）. Similar rates of MACE at one year follow-up period were observed in the two groups（ 4. 76% vs. 2. 79%,χ2= 0. 03,P = 0. 87）. But recurrent angina pectoris（ 40. 48% vs.60. 34%,χ2= 5. 46,P = 0. 02）,the rates of re-revascularization（ 9. 52% vs. 58. 10%,χ2= 32. 13,P = 0. 00） and the readmission（ 11. 90% vs. 27. 93%,χ2= 4. 68,P = 0. 03） were all lower in the treatment group than that of the routine group（ P〈0. 05）,the cardiac function is better in the treatment group than that of the routine group in the follow-up per

关 键 词：血管成形术 经腔 经皮冠状动脉 急性ST段抬高型心肌梗死 非梗死相关血管 多支血管病变 预后 

分 类 号：R542.22[医药卫生—心血管疾病]