直接经皮冠状动脉介入治疗左主干急性闭塞致ST段抬高型心肌梗死患者疗效观察  

Clinical outcomes in patients with ST-segment elevation myocardial infarction caused by unprotected left main coronary artery occlusion treated by primary PCI

作　　者：刘海伟[1] 徐凯[1] 鲍丹[1] 荆全民[1] 王效增[1] 向定成[2] 袁明远[3] 姜铁民[4] 赵仙先 杨丽霞[6] 韩雅玲[1] 

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016 [2]广州军区总医院心内科,广东广州510010 [3]武警广东总队医院心内科,广东广州510507 [4]武警后勤学院附属医院心内科,天津300162 [5]海军军医大学长海医院心内科,上海200433 [6]成都军区昆明总医院心内科,云南昆明650032

出　　处：《创伤与急危重病医学》2017年第6期321-324,共4页Trauma and Critical Care Medicine

基　　金：辽宁省自然科学基金(2014020064)

摘　　要：目的观察直接经皮冠状动脉介入术(p PCI)治疗左主干(LMCA)急性闭塞致ST段抬高型心肌梗死(STEMI)患者的临床疗效。方法在全军心血管介入诊疗管理系统数据库中选取罪犯病变为LMCA(LM组)和非LMCA(n LM组)急性闭塞所导致STEMI的患者行p PCI的临床资料,对比分析两组患者临床特征的差异,以探讨罪犯病变部位不同对患者临床预后的影响。结果本研究共纳入8 878例STEMI患者(LM组147例;n LM组8 731例),两组STEMI患者均接受p PCI。两组患者高脂血症、吸烟及高血压病比例比较,差异无统计学意义(P>0.05)。但LM组患者的心功能Ⅲ~Ⅳ级比例明显高于n LM组患者(13.6%比4.2%,P<0.01)。两组STEMI患者症状到血流开通时间比较,差异无统计学意义(P>0.05)。虽然LM组患者术中主动脉内囊反搏支持及盐酸替罗非班使用比例明显高于n LM组(P<0.01),但LM组患者的围术期心源性病死率仍然明显高于n LM组(P<0.01)。结论与非LMCA患者比较,尽管LMCA患者的围术期心源性病死率较高,但初步结果提示,LMCA急性闭塞导致STEMI接受p PCI治疗患者的住院疗效尚可接受,其长期疗效还需进一步随访观察。Objective To investigate the clinical outcomes of primary percutaneous coronary intervention（pPCI） performed in patients with ST-segment elevation myocardial infarction（STEMI） caused by left main coronary artery（LMCA） acute oc- clusion. Methods The data of STEM! patients performed by pPCI was selected from the military hospitals cardiovascular intervention procedures database. The STEMI patients were divided into the LMCA（ LM group）and no-LMCA（ nLM group） by the culprit lesion location. The differences of clinical features between the two groups were analyzed to investigate the effect of different lesions on the clinical prognosis of patients. Results There were 8 878 cases of STEMI patients （ 147 pa- tients received pPCI in the LM group and 8 731 patients in the nLM group）who underwent pPCI. The rates of hyperlipi- demia, current smoke and hypertension had no statistically significant difference between the two groups （P 〉 O. 05 ）. STEMI patients with heart function m-IV grade were significantly increased in the LM group compared with those in the nLM group（ 13.6% versus 4. 2% ,P 〈0. 01 ）. The symptom-onset-to-balloon times were similar between two groups of patients （P 〉 0. 05）. Although compared to patients in the nLM group, the rates of intra-aortic balloon pump support and glycoprotein II b/Ilia inhibitor Tirofiban Hydrochloride use were significantly increase in the LM group （P 〈 0. 01 ）, the cardiac death during perioperative period were prominent increased in patients of the LM group （ P 〈 0. 01 ）. Conclusion Compared to STEMI patients with no-LMCA lesion,patients with STEMI caused by LMCA acute occlusion still remain much more high cardiac death, and the primary results about the perioperative outcome are acceptable in STEMI patient with LMCA lesion, the long-term effect of the disease will be further followed up.

关 键 词：心肌梗死 冠状动脉左主干 经皮冠状动脉介入 

分 类 号：R542.22[医药卫生—心血管疾病]