摘要
目的探讨不同血运重建策略对全球急性冠状动脉事件注册评分(GRACE评分)高危的急性ST段抬高型心肌梗死(STEMI)多支病变患者预后的影响。方法回顾分析2009年1月1日-2014年6月30日在西京医院心血管内科监护室住院、诊断为STEMI多支病变且GRACE评分高危(>140分)的177例患者,根据是否首次急诊同台或择期行冠状动脉介入治疗(PCI)干预非梗死相关血管,分为完全血运重建组(68例)和不完全血运重建组(109例)。所有患者随访3年,比较两种治疗策略患者主要不良心血管事件(MACE)(包括心源性死亡、再发心肌梗死、缺血驱动血运重建及心力衰竭)、全因死亡、顽固性心绞痛以及全部出血事件[出血学术研究协会(BARC)1–5型]的发生率。结果经过3年随访,完全血运重建组MACE(16.2%vs. 31.2%,P=0.021)、心源性死亡(2.9%vs. 11.9%,P=0.038)及全因死亡(4.4%vs. 14.7%,P=0.034)的发生率明显低于不完全血运重建组,而两组再发心肌梗死(1.5%vs.1.8%,P=0.729)、缺血驱动血运重建(10.3%vs. 12.8%,P=0.446)、心力衰竭(2.9%vs. 10.1%,P=0.062)、顽固性心绞痛(22.1%vs. 22.0%,P=0.711)以及全部出血事件(BARC 1–5型)(1.5%vs. 1.8%,P=0.812)的发生率则无明显差异。结论与不完全血运重建策略相比,完全血运重建策略可明显降低GRACE评分高危的STEMI多支病变患者PCI术后3年MACE的发生率。
Objective To explore the impact of different strategies of percutaneous coronary revascularization on the prognosis of acute ST-segment elevation myocardial infarction（STEMI） patients presenting with multi-vessel disease（MVD） and a high global registry of acute coronary events（GRACE） risk score. Methods A total of 177 selected patients diagnosed as STEMI and MVD with a high GRACE risk score（〉140 points） and admitted in the Department of Cardiology of Xijing Hospital from Jan. 1, 2009 to Jun. 30, 2014 were recruited in present study, and then divided into the culprit-vessel only revascularization（CVR） group（n=109） and complete percutaneous revascularization（CPR） group（n=68）. All the patients were followed up for 3 years, and the differences were compared between the two groups in major adverse cardiovascular events（MACE, a composite endpoint of cardiac death, recurrent myocardial infarction, ischemia-driven revascularization and heart failure）, all-cause death, refractory angina and all bleedings（bleeding academic research consortium type 1-5）. Results During the 3 years of following up, the CPR group resulted in lower rates of MACE（16.2% vs. 31.2%, P=0.021）, cardiac death（2.9% vs. 11.9%, P=0.038） and all cause death（4.4% vs. 14.7%, P=0.034） compared to the CVR group. While no significant difference existed between the two groups in recurrent myocardial infarction（1.5% vs. 1.8%, P=0.729）, ischemia-driven revascularization（10.3% vs. 12.8%, P=0.446）, heart failure（2.9% vs. 10.1%, P=0.062）, refractory angina（22.1% vs. 22.0%, P=0.711） and all bleedings（BARC type 1-5）（1.5% vs. 1.8%, P=0.812）. Conclusion Compared to the strategy of culprit-vessel only revascularization, the complete percutaneous revascularization for STEMI patients with MVD and a high GRACE risk score may significantly reduce the risk of MACE at 3 years follow-up.
作者
许晓明
文亮
李超
程康
XU Xiao-ming;WEN Liang;LI Chao;CHENG Kang(Department of Cardiology,Xijing Hospital,Medical University of the Air Foree,Xi＇an 710032,China;Department of Internal Medicine,Hospital of PLA Unit 93279,Dandong,Liaoning 118008,China;Department of Cardiology,General Hospital of Shenyang Command,Shenyang 110016,China;Department of Cardiology,Xi＇an Third Hospital,Xi＇an 710018,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2018年第9期756-760,共5页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金(81600356)
关键词
ST段抬高型心肌梗死
冠脉多支病变
血运重建
全球急性冠状动脉事件注册评分
ST-segment elevation myocardial infarction
multi-vessel disease
revascularization
global registry of acute coronary events risk score
