从IRA到NON⁃IRA:全面血运重建在STEMI合并MVD患者PCI治疗中的研究进展  

From IRA to NONIRA:Progress in total revascularization for PCI in patients with STEMI and MVD

作　　者：朱能元 曾梦雅 罗颖 陈跃武 ZHU Nengyuan;ZENG Mengya;LUO Ying;CHEN Yuewu(Department of Cardiovascular Internal Medicine,the Second Affiliated Hospital of Hainan Medical University,Haikou 570103,China;Hainan Medical University,Haikou 571199,China;Cardiovascular Systemic Disease Clinical Medical Center of Hainan Province,Haikou 570103,China)

机构地区：[1]海南医科大学第二附属医院心血管内科,海南海口570103 [2]海南医科大学,海南海口571199 [3]海南省心血管系统性疾病临床医学中心,海南海口570103

出　　处：《海南医科大学学报》2025年第3期220-228,共9页Journal of Hainan Medical University

基　　金：国家自然科学基金资助项目(82360063);海南省自然科学基金(高层次人才项目)(821RC1127);海南省重点研发项目(社会发展)(ZDYF2022SHFZ070)。

摘　　要：ST段抬高型心肌梗死(STEMI)合并多支血管病变(MVD)在临床实践中发病率高,与不良预后密切相关。急诊经皮冠状动脉介入治疗(PCI)中,治疗策略的精准选择对患者的长期预后具有显著影响。目前,专家们主要关注三种PCI的策略:(1)仅对梗死相关动脉(IRA)进行血运重建;(2)同步处理IRA与非梗死相关动脉(non-IRA);(3)先对IRA进行PCI,随后在适当时机对non-IRA进行分期PCI。尽管对IRA的处理方案已相对明确,但对non-IRA的处理策略仍存在争议。考虑到MVD中的non-IRA具有特殊的病理生理状态,精准制定血运重建的策略和选择适宜的时机,对于提升患者临床预后具有关键性作用。虽然相关研究持续深入,但针对non-IRA PCI的最佳治疗策略和时机,仍缺乏统一的临床指南。本文综述了该领域对于non-IRA PCI治疗的研究进展,旨在为临床医生选择合适的血运重建策略提供理论指导和参考,以期改善患者的预后。ST-segment elevation myocardial infarction(STEMI),when complicated by multi-vessel disease(MVD),is associated with a high incidence and is strongly correlated with adverse clinical outcomes in medical practice.The choice of emergency percutaneous coronary intervention(PCI)strategy significantly impacts patient outcomes.Currently,experts primarily focus on three PCI strategies:(1)perform revascularization solely on the infarct-related artery(IRA);(2)manage both the IRA and noninfarct-related arteries(non-IRA)concurrently;and(3)conduct PCI on the IRA initially,followed by staged PCI for the non-IRA at an appropriate juncture.While the treatment plan for IRAs has been relatively clear,the approach to non-IRAs remains controversial.Given the unique pathophysiological state of non-IRAs in MVD,selecting an appropriate revascularization strategy and timing is crucial for improving patient prognosis.Despite ongoing research,there is no consensus on the optimal PCI strategy and timing for non-IRAs.This article reviews research progress in the field of non-IRA PCI with the aim of providing theoretical guid-ance and reference for clinicians to select suitable revascularization strategies to enhance patient prognoses.

关 键 词：ST段抬高型心肌梗死 多支血管病变 非梗死相关动脉 经皮冠脉介入 血运重建 

分 类 号：R542.22[医药卫生—心血管疾病]