摘要
目的探讨非梗死相关血管(non-IRA)发生管腔狭窄或慢性完全闭塞性病变(CTO)对急性ST段抬高型心肌梗死(STEMI)患者住院期间预后的影响。方法回顾性分析345例连续入院接受急诊经皮冠状动脉介入治疗(PPCI)的急性STEMI患者的临床资料,根据是否存在冠状动脉多支血管病变或CTO病变进行分组,比较各分组间患者的临床特征、PPCI资料、住院期预后和并发症情况,并采用多因素分析确定住院期间发生主要心血管不良事件(MACE)的独立危险因素。结果 345例急性STEMI患者中共有185例(53.6%)存在冠状动脉多支血管病变,其中110例(31.9%)为双支血管病变,75例(21.7%)为三支血管病变。冠状动脉多支血管病变中合并CTO病变20例(10.8%),占同期PPCI总量的5.8%(20/345)。多支血管病变患者的年龄显著大于单支血管病变患者(P<0.01),原发性高血压、心源性休克、植入≥2枚药物洗脱支架患者的构成比均显著高于单支血管病变患者(P值均<0.05),与单支血管病变患者间梗死相关血管(IRA)构成的差异有统计学意义(P<0.01)。合并CTO病变患者的心力衰竭构成比显著高于不合并CTO病变患者(P<0.05),左心室射血分数显著低于不合并CTO病变患者(P<0.01),与不合并CTO病变患者间术后心肌梗死溶栓试验(TIMI)血流分级构成比的差异有统计学意义(P<0.05)。在住院期间总体患者的MACE发生率为10.4%(36/345),病死率为8.1%(28/345),大出血并发症发生率为1.2%(4/345)。单支血管病变与多支血管病变患者间病死率、再发心肌梗死率、靶血管血运重建率、脑卒中发生率、MACE发生率、大出血发生率的差异均无统计学意义(P值均>0.05),合并CTO病变患者的靶血管血运重建率和MACE发生率均显著高于不合并CTO病变患者(P值均<0.05)。单因素分析结果显示,在住院期间发生MACE的患者中年龄≥75岁、发生心源性休克、发生心力衰竭、术后TIMI血流分级<3级、合并
Objective To assess the impact of multivessel disease and chronic total occlusion （CTO） on in-hospital outcome in aculte ST-elevation myocardial infarction （STEMI） patients undergoing primary percutaneouscoronary intervention （PPCI）. Methods This is a retrospective observational study of 345 acute STEMI patients. Clinical and angiographic characteristics were compared between patients with and without multivessel disease as well as CTO lesion. Logistic regression analysis was applied to the identify the independent risk factors of in- hospital major adverse cardiac events （MACE）. Results There were 185 patients （53.6%） with multivessel disease, including 110 （31.9%） with double vessel disease and 75 （21.7%） with triple vessel disease. CTO lesion was complicated in 20 patients with multivessel disease （5.8 %, 20/345）. Patients with multivessel disease were significantly older and more likely to have hypertension, cardiogenic shock, more stents （at least 2） and more difference in infarction related artery （IRA） location than those with single vessel disease （P〈0. 01 or 0.05）. Patients with coexisting CTO had lower left ventricular ejection fraction （LVEF） and higher incidence of heart failure, and were less likely to achieve thrombolysis in myocardial infarction （TIMI） 3 flow in the IRA post- procedural （P〈0.0t or 0.05）. The total incidence of in-hospital MACE was 10.4% （36/345）, case fatality was 8.1% （28/345） and hemorrhea incidence was 1. 2%. There were no significant differences in terms of case fatality, incidence of recurrent myocardial infarction, target vessel revascularization, stroke, MACE or hemorrhea between patients with multivessel disease and single vessel disease （all P〉0. 05）. The incidence of target vessel revascularization and MACE in the patients with CTO lesion was significantly higher than that in the patients without CTO lesion （P 〈 0. 05）. Univariate analysis showed that the patients suffering from in-hospital MA
出处
《上海医学》
CAS
CSCD
北大核心
2015年第3期199-204,共6页
Shanghai Medical Journal
基金
国家973项目(2006CB503803)
国家863项目(2006AA02A406)资助
