急性ST段抬高性心梗多支病变患者急诊介入术后早期干预重度狭窄非梗死相关冠脉的临床研究  

Early intervention for severe stenosis of non-infarct related artery in patients with acute ST-segment elevation myocardial infarction and multi-vessel disease

作　　者：马贵洲[1] 徐荣和[1] 陈平[1] 蔡志雄[1] 朱稚丹[1] 陈少敏[1] 黄健强[1] 王莹[1] 王文亮[1] MA Guizhou;XU Ronghe;CHEN Ping;CAI Zhixiong;ZHU Zhidan;CHEN Shaomin;HUANG Jianqiang;WANG Ying;WANG Wenliang(Department of Cardiology,Shantou Central Hospital,Shantou 515031,China)

机构地区：[1]广东省汕头市中心医院心内科,广东汕头515031

出　　处：《实用医学杂志》2018年第9期1508-1512,共5页The Journal of Practical Medicine

摘　　要：目的针对多支冠脉病变的急性ST段抬高性心肌梗死(STEMI)患者,在成功进行梗死相关冠脉(IRA)急诊经皮冠状动脉介入术(PCI)后,探讨早期干预重度狭窄的非梗死相关冠脉(non-IRA),分析评估其临床可行性及安全性。方法共有165例患者入选,其中75例患者在急诊PCI术后同意早期干预重度狭窄的non-IRA,另外90例患者仅针对IRA进行干预。分析比较住院期间主要不良事件(全因死亡率、严重心律失常如室速、室颤),造影剂肾病、消化道出血、总住院时间等,以及随访期内全因死亡率、因心衰再次住院、因ACS再次住院、再次冠脉介入、反复心绞痛。结果 (1)住院期间:两组病例的全因死亡率、造影剂肾病发生率、呼吸机应用、严重心律失常(室速、室颤)、消化道出血、肺部感染、菌血症的发生率比较方面无统计学差异(P>0.05),但新发急性左心功能不全发生率方面比较,早期干预重度狭窄non-IRA组低于仅干预IRA组(P<0.05);(2)随访期间:两组病例的全因死亡率比较无统计学差异(P>0.05);而因心衰再次住院、因ACS再次住院、再次冠脉介入、以及反复心绞痛的比较方面,早期干预重度狭窄non-IRA组明显低于仅干预IRA组,差异具有统计学意义(P<0.005)。结论急性STEMI合并多支冠脉病变患者,在行急诊PCI之后早期对重度狭窄non-IRA采取PCI策略是安全可行的。Objective To explore the clinical feasibility and safety of early intervention for severe stenosisof non-infarct related artery（non-IRA）in patients with acute ST-segment elevation myocardial infarction（STEMI）and multi-vessel disease（MVD）after successful primary percutaneous coronary intervention（PCI）for infarct-asso-ciated artery（IRA）. Methods From May 1 st,2011 to December 30 th,2016,165 patients with STEMI andMVD were enrolled in our study. After the completion of primary PCI in IRA,75 patients still in the hospitalagreed to undergo a second staged PCI in severe stenosis of non-infarct arteries. We analyzed the in-hospitaladverse events,the length of hospital stay and clinical outcomes during the follow-up in the study population.Results There was no significant difference in the incidence of adverse events between the two groups during hos-pitalization. However,compared to patients treated with the IRA-only PCI,those treated with early intervention forsevere stenosis of non-IRA was associated with greater benefits for clinical outcomes（including rehospitalization forheart failure,rehospitalization for ACS,recurrent angina pectoris,necessity for reintervention）during the follow-up except for the all-cause mortality. Conclusion Early intervention for severe stenosis of non-IRA is a feasibleand safe procedure in patients with acute STEMI and MVD after successful primary PCI.

关 键 词：急性心肌梗死 冠状动脉多支病变 经皮冠状动脉介入治疗 早期干预 

分 类 号：R542.22[医药卫生—心血管疾病]