急性心肌梗死罪犯病变狭窄程度与预测因素分析被引量：4

Analysis of culprit lesion stenosis severity and its predicting factors in acute myocardial infarcton

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摘要目的评价急性ST段抬高心肌梗死（STEMI）罪犯病变狭窄程度及其预测因素。方法连续回顾阜外心血管病医院2014年5月至2014年10月STEMI急诊经皮冠状动脉介入治疗（PCI）术中采用血栓抽吸患者的影像和临床资料。对血栓抽吸后影像进行冠状动脉造影定量分析,按罪犯病变直径狭窄程度分为非阻塞性病变组和阻塞性病变组,比较两组影像和临床资料特征,并分析非阻塞性病变的临床预测因素。结果共123例符合入选条件,其中非阻塞性病变48例（39.0%）,阻塞性病变75例（61.0%）。非阻塞性病变组罪犯病变狭窄程度[（37.7±8.5）%比（65.2±10.1）%,P=0.000]、靶病变长度[（24.3±12.3）mm比（29.2±13.8）mm,P=0.048]以及支架置入率[33例（68.8%）比69例（92.0%）,P=0.001]均小于阻塞性病变组,而最小管腔直径大于阻塞性病变组[（1.90±0.44）mm比（1.11±0.37）mm,P=0.000]。非阻塞性病变组既往PCI史比例高于阻塞性病变组[13例（27.1%）比5例（6.7%）,P=0.002]。只有既往PCI史是罪犯病变为非阻塞性狭窄的预测因素（OR 4.881,95%CI 1.553-15.339,P=0.007）,而性别、年龄、体质量指数、高血压、糖尿病、高脂血症以及无血管病史等与非阻塞性狭窄预测不具有相关性（均P〉0.05）。结论大约40%的STEMI是由非阻塞性冠状动脉病变所致,既往PCI史是罪犯病变为非阻塞性狭窄的预测因素。 Objective To study the severity of culprit lesion stenosis and its predicting factors in acute ST- segment elevation myocardial infarction（ STEMI）. Methods All the angiographic and clinical data of patients admitted into Fuwai Hospital for STEMI and received PCI with thrombus aspiration between2014 /05- 2014 /10 were retrospectively analyzed. Patients were divided into two groups according to the severity of residual stenosis after aspiration by quantitative coronary angiography： non-obstructive stenosis group（ NS） with diameter stenosis 50% and obstructive stenosis group（ OS） with diameter stenosis≥50%. The angiographic and clinical characteristics were compared between the 2 groups and the possible predicting factors of non-obstructive senosis were further studied. Results A total of 123 patients were included in the study. Among them,48 patients（ 39. 0%） had non-obstructive lesions and 75 patients（ 61. 0%） had obstructive lesions. Compared to the obstructive stenosis group,patients with non-obstructive stenosis showed less degree of stenosis [（ 37. 7 ± 8. 5） % vs.（ 65. 2 ± 10. 1） %,P = 0. 000],shorter lesion length [（ 24. 3 ± 12. 3） mm vs.（ 29. 2 ± 13. 8） mm,P = 0. 048] and less proportion of patients needed stent implantation [68. 8%（ 33 /48） vs. 92. 0%（ 69 /75）,P = 0. 001]. More patients in the nonobstructive stenosis group had prior history of PCI compared with the obstructive stenosis group [27. 1%（ 13 /48） vs. 6. 7%（ 5 /75）,P = 0. 002]. Logistic regression analysis showed past PCI history was the only predictive factor for non-obstructive stenosis to be culprit lesion（ OR 4. 881,95% CI 1. 553- 15. 339,P = 0. 007）. No correlation was found between the culprit lesion with sex,age,BMI,co-morbidities of hypertension,diabetes,dyslipidemia and peripheral artery diseases（ all P〉0. 05）. Conclusions About40% of STEMI was caused by non-obstructive coronary stenosis. Prior history of PCI was a predictive factor for non-obstructive stenosis to be c