ST段抬高型心肌梗死直接PCI术中支架后扩张对冠脉血流及MACE的影响  

Effects of post-dilation on coronary blood flow and MACE events following primary percutaneous coronary intervention in patients with STEMI

作　　者：徐孟成 曾华甦 范例[1] 卓阳 顾俊[1] 张俊峰[1] 范虞琪[1] 王长谦[1] XU Meng-cheng;ZENG Hua-su;FAN Li;ZHUO Yang;GU Jun;ZHANG Jun-feng;FAN Yu-qi;WANG Chang-qian(Department of Cardiology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院心内科,上海黄浦200011

出　　处：《海南医学院学报》2022年第11期828-834,841,共8页Journal of Hainan Medical University

基　　金：上海市科委重点课题资助项目(18411950500);国家自然科学基金资助项目(81870264)。

摘　　要：目的:研究支架后扩张在ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)术中对冠脉血流和住院期间及术后1年主要心血管不良事件(major adverse cardiovascular events,MACE)的影响。方法:对419例(后扩张组,n=259;非后扩张组,n=160)行PPCI术的STEMI患者进行了回顾性研究。测量记录不同手术时刻的校正的TIMI帧数及术后定性比较分析指标。比较两组临床特征及病变特点、手术结束即刻无复流/慢血流的发生率,比较住院期间及1年MACE的发生率。结果:术后最终造影后扩张组较非后扩张组无复流/慢血流发生率略高,但差异无统计学意义(24.3%vs.19.4%,P=0.238)。住院期间两组MACE无明显差异,但在1年随访MACE中,后扩张组靶血管血运重建(target vessel revascularization,TVR)、靶病变血运重建(target lesion revascularization,TLR)的发生率均比非后扩张组低。长期随访MACE事件的发生与年龄(OR=1.078,95%CI=1.038~1.120;P<0.001)、糖尿病史(OR=3.009,95%CI=1.183~7.654;P=0.021)、后扩张(OR=0.192,95%CI=0.067~0.549,P=0.002)独立相关。结论:后扩张不增加住院期间的MACE,包括心脏死亡、非致命性心肌梗死和TVR。在1年MACE随访中,后扩张减少了TVR、TLR事件的发生。Objective:To evaluate the effect of post-dilation on coronary blood flow and major adverse cardiovascular events(MACEs)during hospitalization and 1 year follow-up following primary percutaneous coronary intervention(PPCI)in STsegment elevated myocardial infarction patients.Methods:A total of 419 eligible patients who underwent PPCI due to STEMI were enrolled.The patients were divided into the post-dilation group(n=259)and the non-post-dilation group(n=160).The corrected TIMI frame count,and final quantitative coronary angiography were assessed.Study end points was to compare the clinical characteristics and pathological changes,the incidence of no-reflow and slow-flow immediately after operation,and the incidence of MACE during hospitalization and 1 year follow-up between the two groups.Results:The incidence of final no-reflow and slowflow in the post-dilation group was higher than that in the non-post-dilation group,but the difference was not signifincantly(24.3%vs.19.4%,P=0.238).There was no statistically significance difference in MACEs during hospitalization,but for the 1-year follow-up,the incidence of target vessel revascularization(TVR),and target lesion revascularization(TLR)in the post-dilation group was lower than that in the non-post-dilation group.A multivariable logistic regression model revealed that age(OR=1.078,95%CI=1.038-1.120;P<0.001),history of diabetes(OR=3.009,95%CI=1.183-7.654;P=0.021),and post-dilation(OR=0.192,95%CI=0.067-0.549;P=0.002)were independently correlated with long-term follow-up of MACE.Conclusion:Post-dilatation does not increase poor prognosis during hospitalization,including cardiac death,nonfatal myocardial infarction,and TVR,but can reduce the incidence of TVR and TLR during long-term follow-up.

关 键 词：支架后扩张 直接经皮冠状动脉介入术 急性ST段抬高型心肌梗死 无复流 慢血流 

分 类 号：R542.22[医药卫生—心血管疾病]