摘要
目的当前国内外关于是否干预非梗死相关血管的研究鲜有报道。文中探讨急性ST段抬高型心肌梗死(STEMI)合并多支病变患者经皮冠状动脉介入术(PCI)成功开通梗死相关血管后干预非梗死相关血管的最佳策略。方法回顾性分析2014年1月1日-2016年12月31日期间东部战区总医院心血管内科收治的STEMI合并冠状动脉多支病变患者227例。根据针对非梗死相关血管的不同血运重建策略将研究对象分为仅处理罪犯病变(CO)组164例、立即多支再血管化(I-MVR)组39例以及分期多支再血管化(S-MVR)组24例。比较3组间主要不良心血管事件(MACE)、顽固性心绞痛、心因性再入院以及全因死亡事件的差异,采用logistic回归分析MACE的影响因素。结果术后经过45~80个月随访,CO组、I-MVR组及S-MVR组患者间MACE(39.6%vs 28.2%vs 12.5%,P=0.021)和心因性再入院(57.3%vs 43.6%vs 33.3%,P=0.043)事件发生率差异具有统计学意义;且S-MVR组发生率显著低于其他2组(P<0.05)。MACE中仅再次血运重建事件在各组间存在显著差异(30.5%vs 20.5%vs 8.3%,P=0.047)。CO组顽固性心绞痛发生率显著高于其他2组(P=0.018);3组患者全因死亡事件发生率差异无统计学意义(P=0.566)。Logistic回归分析显示,仅处理罪犯病变、女性、肾功能不全及三支病变是MACE发生的危险因素。结论STEMI合并多支病变患者首次PCI成功开通梗死相关血管后,相比不干预或立即干预非梗死相关血管,择期干预可降低MACE发生率和心因性再入院率,MACE风险的降低主要由较少的再次血运重建事件驱动。
Objective To explore the optimal strategy for intervention of non-infarct-related vessels after successful revascularization of infarct-related vessels by percutaneous coronary intervention(PCI)in patients with ST elevation myocardial infarction(STEMI)and multivessel coronary disease(MVD).Methods We retrospectively analyzed 227 cases of patients with STEMI and MVD who were admitted to the Department of Cardiovascular Medicine of Jinling Hospital from January 1,2014 to December 31,2016.Based on different revascularization strategies for non-infarct-related vessels,patients were separated into three groups:culprit-lesion-only group(CO,164 cases),immediate multivessel revascularization group(IMVR,39 cases),and staging multivessel revascularization group(SMVR,24 cases).Major adverse cardiac events(MACE),refractory angina pectoris,cardiogenic readmission,and all-cause death were compared among these three groups.The influencing factors of MACE were analyzed by logistic regression.Results After 45 to 80 months of postoperative follow-up,significant differences in the incidence of MACE(39.6%vs 28.2%vs 12.5%,P=0.021)and cardiogenic readmission(57.3%vs 43.6%vs 33.3%,P=0.043)in the CO,IMVR and SMVR groups were found,and the incidence in the SMVR group is particularly lower than the other two groups(P<0.05).Furthermore,only revascularization in MACE was significantly different among the three groups(30.5%vs 20.5%vs 8.3%,P=0.047).The incidence of refractory angina pectoris in CO group was notably higher than the other two groups(34.8%vs 17.9%vs 12.5%,P=0.018),and no significant difference was found in all-cause mortality among the three groups(13.4%vs 7.7%vs 8.5%,P=0.566).Logistic regression indicated that culprit lesion only,females,renal insufficiency and triple vessel coronary disease have potential risks to induce MACE.Conclusion After successful revascularization of infarct-related vessels in patients with STEMI and multivessel disease for the prime PCI,staged intervention can reduce the incidence of MACE and cardiogeni
作者
胡闽鑫
宫剑滨
HU Min-xin;GONG Jian-bin(Department of Vasculocardiology,Jinling Hospital,Nanjing Medical University/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)
出处
《医学研究生学报》
CAS
北大核心
2021年第4期388-393,共6页
Journal of Medical Postgraduates
