非梗死相关动脉介入治疗对预后的影响  

Impact of Interventional Therapy of Non Infarct-related Artery on the Prognosis in STEMI Patients

作　　者：陈斌[1] 陆宇[1] 刘娜[1] 杨瑞峰[1] Chen Bin Lu Yu liu Na Yang Ruifeng(Department of Cardiology Department, Beijing Jiangong Hospital, Beijing 100054, China)

机构地区：[1]北京市健宫医院心内科,北京市100054

出　　处：《中国病案》2016年第11期86-89,共4页Chinese Medical Record

摘　　要：目的探讨多支血管病变的急性ST段抬高型心肌梗死患者同期处理非梗死相关动脉病变对预后的影响。方法回顾性入选2006年1月-2015年12月就诊于某院的急性ST段抬高型心肌梗死患者共415例,随访其全因死亡、非致死性心肌梗死和顽固性心绞痛发生情况。结果根据经皮冠状动脉介入治疗手术方式将患者分为2组,163例(41.2%)急性心肌梗死患者纳入经皮冠状动脉介入治疗同期处理非梗死相关动脉组,233例患者(58.8%)纳入仅处理梗死相关动脉组。两组人群年龄、性别、糖尿病和高血压病患病率等指标的差异无统计学意义。另外,两组人群的梗死相关动脉部位分布和病变血管数目的构成也无明显统计学差异。同期处理非梗死相关动脉组和仅处理梗死相关动脉组全因死亡发生率分别为6.7%和14.2%,HR=0.44(95%CI:0.22-0.90),P=0.021,差异有统计学意义。非致死性心肌梗死发生率分别为10.4%和17.6%,HR=0.55(95%CI:0.30-0.99),P=0.047,差异有统计学意义。两组间顽固性心绞痛发生率分别为19.0%和22.7%,差异无统计学意义。结论本研究结果显示同期处理非梗死相关动脉病变可显著降低不良心血管病事件的发生率。Objective To investigate the impact of preventive intervention in the non infarct-related artery（IRA） on the long-term prognosis of patients with multi-vessel diseases. Methods A total of 415 patients with acute ST segment elevation myocardial infarction（STEMI） who were admitted to our hospital from January 2006 to December 2015 were enrolled. The primary end point of the study included all-cause mortality, nonfatal myocardial infarction and refractory angina pectoris. Results Patients were divided into two groups according to the selection of operation strategy, with 163（41.2%） were assigned to culprit PCI group, and 233（58.8%） to the preventive PCI group. There were no significant differences in the aspects of age, gender and the prevalence of diabetes and hypertension between the two groups. The distribution of IRA and the number of vascular lesions were similar in the two groups. All-cause mortality（6.7% versus 14.2%） and the rate of nonfatal myocardial infarction（10.4% versus 17.6%）in the preventive PCI group were lower than the culprit PCI group, and the hazard ratio were 0.44（95%CI：0.22-0.90, P = 0.021） and 0.55（95%CI： 0.30-0.99, P = 0.047） respectively. The rate of refractory angina pectoris had no significant difference between two groups（19.0% versus 22.7%）. Conclusions This research showed that the preventive intervention in the non infarct-related artery could significantly decrease the incidence of adverse cardiovascular events.

关 键 词：急性心肌梗死 多支病变 介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]