多支血管病变急性非ST段抬高型心肌梗死不同手术方式对患者远期预后的比较  

Comparison of long-term prognosis of patients with multivessel disease with acute non-ST-segment elevation myocardial infarction

作　　者：郑梅 李树仁[2] 孙明超 杨玲玲 杨国慧 刘璇[4] 郝潇[2] 肖洒 Zheng Mei;Li Shuren;Sun Mingchao;Yang Lingling;Yang Guohui;Liu Xuan;Hao Xiao;Xiao Sa(North China University of Science and Technology, Tangshan 063000, China)

机构地区：[1]华北理工大学,唐山063000 [2]河北省人民医院心血管内一科,石家庄050000 [3]石家庄市第一医院心电图室,石家庄050000 [4]河北医科大学,石家庄050000

出　　处：《中国循证心血管医学杂志》2019年第6期746-749,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的比较非ST段抬高型心肌梗死(NSTEMI)合并多支血管病变,不同处理方式,仅处理罪犯血管(COR)和一次性完全血运重建(CR),两种不同的处理方式对患者远期预后的影响。方法回顾性分析2016年1月至2018年5月于我院心血管内科行PCI治疗的NSTEMI患者140例,根据NSTEMI合并多支血管病变处理方式的不同,排除失访,将患者分为COR组(n=95)和CR组(n=35)。收集入选者性别、年龄、吸烟史、高血压、糖尿病、生化指标、超声心动图指标、介入手术相关指标等基线资料,比较两种不同的处理方式对于NSTEMI合并多支血管病变患者远期预后的影响。结果 NSTEMI合并多支血管病变患者,平均随访11.25(5.38,15.13)个月,在复合终点(全因死亡,再发心肌梗死,再次血运重建,心绞痛住院)方面,CR与COR相比(8.57%vs. 6.32%,P=0.035),差异有统计学意义;在次要终点(心绞痛复发,出血,心律失常,心力衰竭住院,卒中)方面,CR与COR相比(48.58%vs. 23.15%,P=0.031),两组间差异仍有统计学意义。结论对于NSTEMI合并多支血管病变患者,COR可能为一个理想的策略,尚需多中心、前瞻性、随机对照试验进一步证实。Objective The effects of different treatments on long-term prognosis were compared of non-STsegment elevation myocardial infarction with multivessel vessel disease. The different treatment methods include only dealing with culprit-only revascularization(COR) and one-time complete revascularization(CR). Methods A total of 140 patients treated in Hebei General Hospital from 2016-01 to 2018-05 were enrolled. According to the different treatment methods of NSTEMI combined with multivessel disease, the patients were excluded and the patients were divided into COR groups.(n=95) and CR group(n=35). Baseline data such as gender, age, smoking history, hypertension, diabetes, biochemical indicators, echocardiographic index, and interventional surgery related indicators were collected to compare the long-term prognosis of NSTEMI patients with multivessel disease. Results NSTEMI patients with multivessel disease were followed up for an average of 11.25(5.38, 15.13) months. In the composite end point(all-cause death, recurrent myocardial infarction, revascularization, angina hospitalization),CR was compared with COR(8.57% vs. 6.32%, P=0.035), the difference was statistically significant. And there was a statistical difference between the two groups. In the secondary end point(angina recurrent, bleeding, arrhythmia,heart failure hospitalization, stroke), we compared one-time complete revascularization(CR) with culprit-only revascularization(48.58% vs. 23.15%, P=0.031). The difference between the two groups was still statistically significant. Conclusion For patients with NSTEMI complicated with multivessel disease, COR may be an ideal strategy and needs further confirmation in a multicenter, prospective, randomized controlled trial.

关 键 词：非ST段抬高型心肌梗死 多支血管病变 经皮冠状动脉介入治疗 罪犯血管 一次性完全血运重建 

分 类 号：R541.4[医药卫生—心血管疾病]