不同血运重建策略对老年非ST段抬高型急性冠脉综合征合并多支血管病变患者预后的影响  

Prognostic impact of different revascularization strategies in the elderly with non-ST elevation acute coronary syndrome complicated with multivessel disease

作　　者：王崇振 王选琦 黄莉 WANG Chong-Zhen;WANG Xuan-Qi;HUANG Li(Department of Cardiology, the Fourth People＇ s Hospital of Shaanxi Province, Xi＇ an 710043, China)

机构地区：[1]陕西省第四人民医院心血管内科,西安710043

出　　处：《中华老年多器官疾病杂志》2017年第12期934-938,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的比较一次与分次经皮冠状动脉介入(PCI)治疗完全血运重建对高龄非ST段抬高型急性冠脉综合征(NSTE-ACS)合并多支血管病变(MVD)患者预后的影响。方法回顾性分析陕西省第四人民医院心血管内科2016年6月至2017年1月住院治疗的高龄NSTE-ACS合并MVD患者110例,其中男性67例,女性43例,年龄(63.1±8.5)岁。根据完全血运重建策略不同分为一次PCI组(n=48)和分次PCI组(n=62),比较两组患者PCI治疗、住院期间主要并发症和院内主要不良心血管事件(MACEs)发生率。术后对患者随访6个月,比较两组心功能、心绞痛症状改善情况和MACEs发生率。采用SPSS 19.0统计软件对数据进行分析。组间比较采用t检验或x^2检验。结果患者术前左室射血分数(LVEF)和院内全球急性冠状动脉事件注册(GRACE)评分差异无统计学意义(P>0.05)。分次PCI组单次造影剂用量明显低于一次PCI组[(180.0±60.0)vs(230.0±70.0)ml,P=0.04],院内MACEs和住院期间主要并发症较一次次PCI组显著降低[1.6%(1/62)vs 10.4%(5/48),P=0.04;4.8%(3/62)vs 18.8%(9/48),P=0.02]。随访6个月结果表明分次PCI组较一次PCI组MACEs发生率降低[4.9%(3/61》)vs 17.4%(8/46),P=0.03]。结论分次PCI完全血运重建安全有效,可能是高龄NSTE-ACS合并MVD患者优先选用的介入治疗策略。 Objective To compare the prognostic impact of different revascularization strategies, multi-staged versus single-staged percutaneous coronary intervention（PCI）in the elderly patients with non-ST elevation acute coronary syndrome（NSTE-ACS）compli-cated with multivessel disease（MVD）.Methods A retrospective study was carried out on 110 elderly patients[67 males and 43 females, at an age of（63.1 ±8.5）years]suffering from NSTE-ACS complicated with MVD who were admitted in our department from June 2016 to January 2017.According to the revascularization, they were divided into single-staged PCI group（n=48）and multi-staged PCI group（n=62）.The data of PCI and incidences of complications and major adverse cardiovascular events（MACEs）during hospitalization were observed and compared between the 2 groups.In the end of the 6 months＇ follow-up, heart function, relief of angina symptoms,and occurrence of MACEs were compared between the 2 groups.SPSS statistics 19.0 was used to analyze the data. Student＇s t test or Chi-square test was adopted for the comparison between the 2 groups.Results There were no significant differences in left ventricular ejection fraction（LVEF）and the in-hospital global registry of acute coronary events（GRACE）risk score before the operation between the 2 groups（P 〉0.05）.The multi-staged PCI group had less usage of contract in coronary angiography [（180.0 ±60.0）vs（230.0 ±70.0）ml,P=0.04],and lower incidences of in-hospital MACEs[1.6%（1/62）vs 10.4%（5/48）, P=0.04]and complications[4.8%（3/62）vs 18.8%（9/48）, P=0.02]when compared with the single-staged PCI group.The occurrence of MACEs was also lower in the multi-staged group than the single-staged group in the end of follow-up[4.9%（3/61）vs 17.4%（8/46）,P=0.03].Conclusion Multi-staged PCI is safe and effective for revascularization,and it might be an optimal strategy for the elderly NSTE-ACS patients complicated with MVD.

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入治疗 多支血管病变 完全血运重建 主要不良心血管事件 

分 类 号：R541[医药卫生—心血管疾病]