非支架植入策略对急性ST段抬高型心肌梗死患者临床预后的影响  

Effect of Non-stent Implantation Strategy on Clinical Outcomes of Patients with Acute ST-segment Elevation Myocardial Infarction

作　　者：罗德谋[1] 叶景光[1] 孙硕[1] 张上鸿 董豪坚 LUO Demou;YE Jingguang;SUN Shuo;ZHANG Shanghong;DONG Haojian(Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences),South-ern Medical University,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所,南方医科大学附属广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2023年第6期575-579,599,共6页South China Journal of Cardiovascular Diseases

基　　金：河源市科技局《急性胸痛患者一体化救治体系建设研究》(项目编号:河科社农大专项2022016)。

摘　　要：目的 比较非支架植入策略(non-stent implantation strategy,NS)与支架植入策略(stent implantation strategy,S)对急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者临床预后的影响。方法 回顾性纳入2018年1月至2020年1月因STEMI就诊于广东省人民医院、广东省人民医院珠海医院、揭西人民医院的患者共245例,其中共51例STEMI患者接受了延迟支架策略,NS组21例,S组30例,分析其临床资料。对患者接受直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗预处理后及1周后再次接受PCI治疗后的冠状动脉造影(coronary angiography,CAG)影像资料进行记录和分析:“罪犯”血管的心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级和TIMI心肌灌注分级(TIMI myocardial perfusion grading,TMPG)。对术中血管内超声(intravascular ultrasound,IVUS)的影像特点进行记录和分析并对所有患者进行1年和2年的临床随访[主要不良心血管事件(major cardiovascular adverse events,MACEs)]。结果 NS组与S组的患者经直接PCI治疗预处理后、首次PCI治疗后1周再次PCI治疗或CAG均显示,“罪犯”血管的TIMI血流分级比较,差异无统计学意义(P>0.05)。首次PCI治疗后1周再次PCI治疗或CAG显示S组患者心肌TMPG灌注分级比NS组更优,差异有统计学意义(P<0.05)。两组患者的IVUS影像特点包括最小管腔直径(MLD)、最小管腔面积(MLA)、重构指数(RI)及斑块负荷(PB)等比较,差异无统计学意义(P>0.05)。两组患者的第1年和第2年临床随防显示MACEs发生率比较,差异无统计学意义(P>0.05)。结论 在基于循证医学的规范药物治疗基础上,若STEMI患者在接受首次PCI预处理后“罪犯”血管达到理想的前向血流、“罪犯”病变残余狭窄明显改善,非支架植入策略可能成为一种有效和可行的选择。Objectives To compare the effect of non-stent implantation strategy(NS)and stent implantation strategy(S)on the clinical prognosis of patients with acute ST-elevation myocardial infarction(STEMI).Methods Totally 245 patients with STEMI from January 2018 to January 2020 in Guangdong Provincial Peoples Hospital,Guangdong Provin-cial Peoples Hospital Zhuhai Hospital,Jiexi Peoples Hospital were retrospectively included,among them 51 STEMI patients underwent delayed stenting,including 21 patients in NS group and 30 patients in S group.The coronary angiog-raphy(CAG)image data of the patients after direct percutaneous coronary intervention(PCI)pretreatment and after re-interventional therapy 1 week later were recorded and analyzed:thrombolysis in myocardial infarction(TIMI)blood flow classification of the offenders blood vessels and myocardial TIMI myocardial perfusion grading(TMPG)perfusion classification.The imaging features of intraoperative intravascular ultrasound(IVUS)were recorded and analyzed,and all the patients were followed up for 1 and 2 years[major cardiovascular adverse events(MACEs)].Results There was no statistically significant difference in TIMI blood flow classification between NS group and S group after direct PCI pretreatment,and the same again after the first PCI one week by PCI or CAG(P>0.05).The TMPG of patients in S group was better than that in NS group after the first PCI one week by PCI or CAG(P<0.05).The IVUS imaging features,including minimum lumen diameter(MLD),minimum lumen area(MLA),remodeling index(RI)and plaque load(PB),had no significant differences between the two groups(P>0.05).There was no significant difference in MACEs between the two groups at the first and second year(P>0.05).Conclusions On the basis of standardized drug therapy based on evidence-based medicine,non-stent implantation strategy may be an effective and feasible option for STEMI patients to achieve ideal forward blood flow and significantly improve residual stenosis of the offender lesion after the first PCI.

关 键 词：心肌梗死 非支架植入策略 心肌梗死溶栓试验血流分级 血管内超声 延迟支架策略 

分 类 号：R542.22[医药卫生—心血管疾病]