STEMI伴多支血管病变患者非梗死相关动脉的处理时机  

Timing of non-infarct-related arterial management in ST-elevation myocardial infarction patients combined with multivessel coronary artery disease

作　　者：周汉力 夏中华 黄兴杰 林创标 刘琼 黄敏 周国良 张羽中 ZHOU Hanli;XIA Zhonghua;HUANG Xingjie(Department of Cardiology,the Second Affiliated Hospital of Guilin Medical University,Guangxi,Guilin 541199,China)

机构地区：[1]桂林医学院第二附属医院心内科,广西壮族自治区桂林市541199

出　　处：《河北医药》2023年第15期2261-2265,共5页Hebei Medical Journal

基　　金：广西自然科学基金面上项目(编号:2022JJA140012);广西高校中青年教师科研基础能力提升项目(编号:2019KY0550);疾病诊治技术及规范化研发与应用06-桂林市科技计划项目(编号:20190218-6-2)。

摘　　要：目的研究ST段抬高型心肌梗死(STEMI)合并多支血管病变(MVD)患者经皮冠状动脉介入治疗(PCI)对非梗死相关动脉(non-IRA)血运重建的最佳时机,为国内STEMI合并MVD的PCI治疗策略的制定提供依据。方法2019年1月至2020年8月因STEMI伴MVD治疗且符合入组标准的126例患者,根据急诊PCI到分期处理non-IRA的时间将患者分为3组:A组(同期处理组,n=44),B组(3~10 d分期PCI组,n=41),C组(11~60 d分期PCI,n=41)。对3组患者进行为期14(8,26)个月的随访。随访的终点为主要心脏不良事件(MACE),包括全因死亡、心原性死亡、非致死性心肌梗死、再次血运重建以及因心衰或者心绞痛再次住院。结果A组MACE发生率为15.9%,B组为22.0%,C组为39.0%,C组发生率最高,3组发生率比较差异有统计学意义(P=0.030);Cox风险模型显示C组MACE发生风险高于A组(HR:2.681,95%CI:1.064~6.758,P=0.037),B组高于A组发生MACE的风险为(HR:1.188,95%CI:0.374~3.776,P=0.770),但差异无统计学意义(P>0.05)。结论与同期对non-IRA进行PCI和3~7 d的早期对non-IRA进行PCI相比,11 d后对non-IRA进行PCI发生MACE风险最高,出院前对STEMI患者non-IRA进行血运重建可明显改善预后。Objective To explore the optimal time point of non-infact-related artery(non-IRA)revascularization in patients with ST-elevation myocardial infarction(STEMI)combined with multivessel coronary artery disease(MVD)who were intervened by percutaneous coronary intervention(PCI),thus providing references foRformulating therapeutic strategies foRSTEMI patients combined with MVD managed by PCI in China.Methods From January 2019 to August 2020,126 eligible STEMI patients combined with MVD were included.They were divided into three groups according to the time from emergency PCI to staged treatment of non-IRA:group A(concurrent treatment,n=44),group B(3-10 days to staged PCI,n=41),and group C(11-60 days to staged PCI,n=41).Patients in the three groups were followed up foR14(8,26)months.The endpoint was the rate of majoRadverse cardiovasculaRevents(MACEs),including all-cause death,cardiogenic death,nonfatal myocardial infarction,revascularization,and rehospitalization foRheart failure oRangina.Results There was a significant difference in the incidence of MACEs among group A,B and C(15.9%vs 22.0%vs 39.0%,P=0.030).The Cox risk model showed that the risk of MACEs in group C was significantly higheRthan that in group A(HR=2.681,95%CI[1.064,6.758],P=0.037),which,in group B was higheRthan that in group A(HR=1.188,95%CI[0.374,3.776],P=0.770),but the difference was not statistically significant.Conclusion Compared with non-IRA intervention managed concurrently with PCI oR3-7 days afteRPCI(early stage),the risk of MACEs is the highest to those who are managed by non-IRA intervention 11 days following PCI.Non-IRA revascularization in STEMI patients combined with MVD before discharge effectively improves the prognosis.

关 键 词：STEMI 多支血管病变 非犯罪血管 处理时期 

分 类 号：R543.31[医药卫生—心血管疾病]