直接完全血运重建对老年急性ST段抬高型心肌梗死合并多支血管病变患者预后影响的前瞻性分析  

Prospective analysis of the effect of direct complete revascularization on the prognosis of elderly patients with acute ST-segment elevation myocardial infarction complicated with multivessel disease

作　　者：聂毛晓[1] 陈青[1] 赵全明[1] Nie Maoxiao;Chen Qing;Zhao Quanming(Department of Cardiology,Beijing Anzhen Hospital,Capital MedicalUniversity,Beijing 100029,China)

机构地区：[1]北京市首都医科大学附属北京安贞医院心内科

出　　处：《中国循证心血管医学杂志》2019年第5期530-533,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金(81370437)

摘　　要：目的本研究旨在比较老年急性ST段抬高型心肌梗死(STEMI)合并多支血管病变患者采取不同策略血运重建对预后的影响。方法前瞻性分析2012年9月至2015年8月就诊于首都医科大学附属北京安贞医院心内科接受急诊经皮冠状动脉(冠脉)介入治疗(PCI)且符合STEMI合并多支病变(病变血管≥2支)、年龄≥60岁的281例患者,按冠脉血运重建情况分为直接完全血运重建组(77例),分次血运重建组(204例)。结果两组患者性别构成比、高血压、糖尿病、冠脉病变情况等均无明显差异;住院期间直接完全血运重建组急性血栓事件发生率明显高于分次血运重建组(6.5%vs.1.5%,P=0.032),但两组患者住院期间的心衰发生率(1.0%vs.1.3%,P=0.329)、心脏压塞(0vs.0,P=1.000)、出血并发症(2.5%vs.2.6%,P=0.840)、外周血管血栓事件发生率(1.0%vs.1.3%,P=0.329)无明显差别;平均随访24.9±5.8月,随访期间两组患者的心源性死亡发生率(1.8%vs.2.0%,P=0.811)、再梗死发生率(5.4%vs.5.2%,P=0.442)、卒中(4.4%vs.3.9%,P=0.643)、再次血运重建比例(7.8%vs.6.5%,P=0.589)和再住院率(48.0%vs.50.6%,P=0.529)无显著差别。结论与分次血运重建组相比,直接完全血运重建策略对老年急性ST段抬高型心肌梗死合并多支血管病变的患者预后无显著改善,而且有增加术后急性血栓事件的风险。Objective This study was designed to compare the effects of different strategies of revascularization on the prognosis of elderly patients with acute ST-segment elevation myocardial infarction complicated with multivessel disease. Methods A total of 281 elder patients (age≥60 years) which combined multi-vessel disease (pathological vessels ≥ 2) and underwent emergency percutaneous coronary intervention (PCI) in the Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,from September 2012 to August 2015 were enrolled. Patients were divided into direct complete revascularization group (77 cases) and divided revascularization group (204 cases) according to coronary revascularization. Results There were no significant differences in sex ratio,hypertension,diabetes mellitus and coronary artery lesions between the two groups. The incidence of acute thrombosis in the direct complete revascularization group was significantly higher than that in the divided revascularization group (6.5% vs. 1.5%,P=0.032),but the incidence of heart failure in the two groups during hospitalization (1.0% vs. 1.3%,P=0.329),cardiac tamponade (0 vs. 0,P=1.000),hemorrhagic complications (2.5% vs. 2.6%,P=0.840),incidence of peripheral vascular thrombosis events (1.0% vs. 1.3%, P=0.329) had no significant difference. The mean follow-up was 24.9±5.8 months,and The incidence of cardiac death between the two groups was 1.8% vs. 2.0%,P=0.811). The incidence of re-infarction (5.4% vs. 5.2%,P= 0.442),stroke (4.4% vs. 3.9%,P=0.643),revascularization (7.8% vs. 6.5%,P=0.589) and re-hospitalization (48.0% vs. 50.6%,P=0.529) had no significant difference. Conclusion Compared with the divided revascularization group, direct total revascularization strategy did not significantly improve the prognosis of elderly patients with acute STsegment elevation myocardial infarction complicated with multi-vessel lesions,and increased the risk of acute thromboembolic events after surgery.

关 键 词：老年患者 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]