急性ST段抬高型心肌梗死合并慢性闭塞病变的近远期预后分析  

The acute and long-term outcome of patients with ST segment elevation myocardial infarction concurrent with chronic total occlusion

作　　者：王天杰[1] 董军乐 王妍[1] 赵延延 陈舸 钱海燕[1] 袁建松[1] 宋雷[1] 乔树宾[1] 杨进刚[1] 杨伟宪[1] 杨跃进[1] 代表中国急性心肌梗死注册登记研究组 Wang Tianjie;Dong Junle;Wang Yan;Zhao Yanyan;Chen Ge;Qian Haiyan;Yuan Jiansong;Song Lei;Qiao Shubin;Yang Jingang;Yang Weixian;Yang Yuejin;on behalf of China Acute Myocardial Infarction(CAMI)Registry Research Group(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,China Academy of Medical Science and Peking Union Medical College,Beijing 100037,China;不详)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院冠心病中心,100037 [2]不详

出　　处：《中华心血管病杂志》2021年第6期586-592,共7页Chinese Journal of Cardiology

基　　金：国家“十二五”科技支撑计划课题(2011BAI11B02);中国医学科学院医学与健康科技创新工程(2016-I2M-1-009)。

摘　　要：目的评估接受急诊介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者同时合并慢性闭塞病变(CTO)时其近远期预后。方法研究纳入中国急性心肌梗死患者前瞻性注册研究中接受急诊PCI的11905例STEMI患者,根据造影结果分为合并CTO组和不合并CTO组。收集2组的基线临床资料,并根据基线资料进行1∶3倾向评分匹配。对2组患者进行随访,主要研究终点为住院期间和术后1年死亡率,次要研究终点为1年时的总心血管不良事件率,包括死亡、再发心肌梗死、再次血运重建、心力衰竭(心衰)再入院、卒中、严重出血等。结果合并CTO的患者STEMI共931例,男性755例(81.1%),年龄(62.2±11.4)岁,占所有STEMI患者的7.8%。非合并CTO的STEMI患者共10974例,男性8829例(80.5%),年龄(60.0±11.8)岁。进行倾向评分匹配后STEMI合并CTO组纳入896例患者,STEMI不合并CTO组纳入2688例患者,与不合并CTO组相比,STEMI合并CTO组住院期间死亡率较高(4.2%比2.4%,P=0.006),随访1年期间全因死亡率(8.5%比4.4%,P<0.001)、心原性死亡率(5.3%比2.6%,P=0.001)和总MACE发生率(35.1%比23.3%,P<0.001)较高。多因素logistic回归分析提示合并CTO(HR=1.54,95%CI 1.06~2.22,P=0.022)、高龄(HR=1.06,95%CI 1.04~1.08,P<0.001)和既往存在心衰病史(HR=4.10,95%CI 1.90~8.83,P<0.001)是接受急诊PCI的STEMI患者术后1年死亡的独立危险因素。结论合并CTO的STEMI患者住院期间和1年死亡率较高,合并CTO、高龄和既往存在心衰病史是STEMI患者1年死亡的独立危险因素。Objective To evaluate the acute and long-term outcome of patients with ST segment elevation myocardial infarction(STEMI)concurrent with chronic total occlusion(CTO)undergoing primary percutaneous coronary intervention(PCI).Methods 11905 STEMI patients from the China Acute Myocardial Infarction Registry were enrolled in this study and divided into CTO group and non-CTO group according to the angiography results of primary PCI.1∶3 propensity score matching was used to match the patients between the two groups.The primary endpoint was in-hospital mortality and mortality at 1-year post PCI.The secondary endpoint was major adverse cardiovascular events(MACE)including death,re-myocardial infarction,revascularization,heart failure associated readmission,stroke and major bleeding at 1-year post PCI.Results There were 931 CTO patients(7.8%)in this cohort(male=755(81.1%),mean age(62.2±11.4 years)).The rest 10974 patients were STEMI without CTO(male=8829(80.5%),mean age(60.0±11.8)years).After propensity score matching,896 patients were enrolled in CTO group and 2688 in non-CTO group.In-hospital mortality was significantly higher in the CTO group than in non-CTO group(4.2%vs.2.4%,P=0.006).The ratio of all cause death,cardiac death,and MACE at 1-year follow up was also significantly higher in the CTO group than in non-CTO group(8.5%vs.4.4%,P<0.001,5.3%vs.2.6%,P=0.001,35.1%vs.23.3%,P<0.001,respectively).Multiple regression analysis showed that CTO(HR=1.54,95%CI 1.06-2.22,P=0.022),advanced age(HR=1.06,95%CI 1.04-1.08,P<0.001),and previous heart failure history(HR=4.10,95%CI 1.90-8.83,P<0.001)were independent risk factors of 1-year mortality.Conclusions The in-hospital and 1-year mortality increased significantly in STEMI patients concurrent with CTO.CTO,advanced age and history of heart failure are independent risk factors of 1-year death among STEMI patients.

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 慢性闭塞病变 

分 类 号：R542.22[医药卫生—心血管疾病]