摘要
目的研究合并非梗死相关血管慢性完全闭塞(CTO)病变对急性ST段抬高型心肌梗死(STEMI)患者预后的影响。方法选取2014年3月至2015年3月中国人民解放军第92医院心内科收治的170例经皮冠状动脉介入治疗(PCI)的急性STEMI患者为研究对象,其中合并非梗死相关血管慢性完全闭塞者20例(CTO组),非梗死相关血管无慢性完全闭塞者150例(无CTO组)。比较两组患者的临床特征、介入治疗情况及随访结果,并分析影响患者预后的危险因素。结果与无CTO组比较,CTO组糖尿病、既往心肌梗死、多支血管病变及心源性休克患者所占比例较多,分别为40.0%、15.0%、100.0%及35.0%;无CTO组患者院内死亡率为6.3%,明显低于CTO组的21.4%,且两者比较差异有统计学意义(P<0.05);CTO组患者在6个月及一年时的心血管病变死亡发生率为28.5%、35.7%,明显高于无CTO组的5.5%、8.7%,且差异均有统计学意义(P<0.05)。通过COX回归分析发现糖尿病、左室射血分数<40%、心源性休克、梗死相关血管为左前降支以及年龄>75岁是影响患者预后的独立危险因素。结论非梗死相关血管慢性完全闭塞病变可增加急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗的死亡率,而且患者预后多不良。
Objective To study the effect of chronic total occlusion(CTO) in a non-infarct-related artery on the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI). Methods One hundred and seventy patients with acute STEMI treated by percutaneous coronary intervention(PCI) in the Department of Cardiology, No.92 Hospital of Chinese PLA from March 2014 to March 2015 were selected, including 20 patients with chronic total occlusion in a non-infarct-related artery(CTO group) and 150 patients without chronic total occlusion in a non-infarct-related artery(non-CTO group). The clinical data, interventional therapy status, follow-up results of the two groups were compared, and the risk factors of short-term and long-term prognosis were analyzed. Results In CTO group, patients with diabetes, previous myocardial infarction, multivessel disease and cardiogenic shock accounted for 40.0%,15.0%, 100.0% and 35.0%, which were significantly higher than those of non-CTO group. The hospital mortality rate was 6.3% in non-CTO group, which was significantly lower than that of CTO group of 21.4%(P<0.05). The 6-month and one-year cardiovascular disease death rates were 28.5%, 35.7%, significantly higher than those of non-CTO group of5.5%, 8.7%(P<0.05). Cox regression analysis showed that diabetes, left ventricular ejection fraction less than 40%, cardiogenic shock, infarct-related left anterior descending, and age more than 75 years were the independent prognostic factors. Conclusion Chronic total occlusion of non-infarct-related artery can increase the mortality rate of percutaneous coronary intervention in patients with acute STEMI, and the prognosis is often poor.
出处
《海南医学》
CAS
2016年第24期3978-3980,3981,共4页
Hainan Medical Journal
