急性心肌梗死合并多支血管病变患者非梗死相关动脉处理的时机

doi:10.6040/j.issn.1671-7554.0.2015.1235

摘要/Abstract

摘要： 目的探讨急性心肌梗死(AMI)合并多支血管病变(MVD)患者经皮冠状动脉介入治疗(PCI)开通非梗死相关动脉(Non-IRA)的最佳时机。方法纳入AMI合并MVD患者357例,根据是否干预及干预Non-IRA的时机分为对照组(只干预罪犯血管且未择期开通Non-IRA)(n=117)、MV-PCI组(急诊PCI同时开通Non-IRA)(n=32)、0~7 d组(n=28)(排除MV-PCI患者)、8~30 d组(n=84)、31~60 d组(n=96),随访2年。比较各组基本临床资料、冠脉造影\PCI情况和2年内主要心血管不良事件(MACE)等。结果院内MACE发生率对照组最低(3.4%),其次为31~60 d组(4.2%),MV-PCI组最高(18.8%)(P=0.02)。随访MACE发生率对照组最高(59.8%)(P<0.01)。累积MACE发生率31~60 d组最低(18.80%)(P<0.01)。结论 PCI干预非梗死相关动脉能够改善预后;急诊PCI一次性完全血运重建风险较大;心肌梗死后31~60 d为干预AMI患者非梗死相关动脉的较理想时机。

关键词: 经皮冠状动脉, 预后, 心肌梗死, 多支血管病变, 非梗死相关动脉

Abstract: Objective To explore the timing of percutaneous coronary intervention(PCI)for non-infarct-related artery(Non-IRA)in patients with acute myocardial infarction(AMI)and multi-vessel disease(MVD). Methods A total of 357 cases of AMI and MVD were divided into 5 groups according to whether and when they underwent PCI for Non-IRA: control group(n=117, who underwent PCI for culprit vessel only), MV-PCI group(n=32, who underwent PCI simultaneously for both culprit vessel and Non-IRA), 0-7d group(n=28, who underwent PCI for Non-IRA within 7 day); 8-30 d group(n=84, who underwent PCI for Non-IRA within 8-30 days), 31-60 d group(n=96, who underwent PCI for Non-IRA within 31-60 days). All patients were followed up for 2 years. Clinical characteristics, data collected during surgery and major adverse cardiac event(MACE)were analyzed. Results The incidence of in-hospital MACE was the highest in the MV-PCI group(18.8%), the lowest in the control group(3.4%), and the second lowest in the 31-60 d group(P=0.02). The incidence of follow-up MACE was the highest in the control group(59.8%)(P<0.01), and the cumulative rate of MACE was the lowest in the 31-60 d group(18.80%)(P<0.01). Conclusion PCI of Non-IRA can improve the prognosis. Emergency PCI for simultaneous culprit vessel and Non-IRA is risky. Its advisable to choose PCI for Non-IRA within 31-60 days after AMI.

Key words: Prognosis, Myocardial infarction, Multivessel disease, Non-infarct-related artery, Percutaneous coronary

中图分类号:

R541.4

李晓宁,崔连群. 急性心肌梗死合并多支血管病变患者非梗死相关动脉处理的时机[J]. 山东大学学报（医学版）, 2016, 54(8): 50-54.

LI Xiaoning, CUI Lianqun. Treatment timing of non-infarct-related artery in patients with multi-vessel disease and acute myocardial infarction[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 50-54.

参考文献

[1] Shihara M, Tsutsui H, Tsuchihashi M, et al. In-hospital and one year outcomes for patients undergoing percutaneous coronary intervention for acute myocardial infarction[J]. Am J Cardiol, 2002, 90(9):932-936.
[2] Sorajja P, Cersh BJ, Cox DA, et al. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction [J]. Eur Heart J, 2007, 28(14):1709-1716.
[3] O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [J]. J Am Coll Cardiol, 2013, 61(4):485-510.
[4] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南[J]. 中华心血管病杂志, 2010, 38(8):675-690. China Society of Cardiology of Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology. Guideline for diagnosis and treatment of patients with ST-elevation myocardial infarction [J]. Chin J Cardiol, 2010, 38(8):675-690.
[5] Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction[J]. N Engl J Med, 2013, 369(12):1115-1123.
[6] Moreno R, García E, Elízaga J, et al. Results of primary angioplasty in patients with multivessel disease[J]. Rev Esp Cardiol, 1998, 51(7):547-555.
[7] Kornowski R, Mehran R, Dangas G, et al. Prognosis impact of staged versus “one-time” multivessel percutaneous intervention in acute myocardial infarction:analysis from the HORIZONS-AMI(harmonizing outcomes with revascularization and stents in acute myocardial infarction)trial[J]. J Am Coll Cardiol, 2011, 58(7):704-711.
[8] 朱华刚, 孟帅, 贾若飞, 等. 梗死相关血管PCI和择期完全PCI策略在急性ST段抬高型心肌梗死合并多支病变患者中的预后分析[J]. 疑难病杂志, 2014, 13(7):661-664. ZHU Huagang, MENG Shuai, JIA Ruofei, et al. Culprit vessel only versus staged percutaneous coronary intervention for multi-vessel disease in patients presenting with ST segment elevation myocardial infarction[J]. Chin J Diffic and Compl Cas, 2014, 13(7):661-664.
[9] Gibson CM, Ryan KA, Murphy SA, et al. Impaired coronary blood flow in nonculprit arteries in the setting of acute myocardial infarction[J]. J Am Coll Cardiol, 1999, 34(4):974-982.
[10] Murphy SA, Chen C, Gourlay SG, et al. Impairment of myocardial perfusion in both culprit and nonculprit arteries in acute myocardial infarction:a LIMIT AMI substudy [J]. Am J Cardiol, 2003, 91(3):325-328.
[11] Gardne GS, Frisch DR, Murphy SA, et al. Effect of rescue or adjunctive percutaneous coronary intervention of the culprit artery after fibrinolytic administration on epicardial flow in nonculprit arteries[J]. Am J Cardiol, 2004, 94(1):178-180.
[12] Goldstein JA, Demetriou D, Grines CL, et al. Multiple complex coronary plaques in patients with acute myocardial infarction [J]. N Engl J Med, 2000, 343(13):915-922.
[13] Politi L, Sgura F, Rossi R, et al. A randomised trial of target-vessel versus multi-vessel revascularization in ST-elevation myocardial infarction:major adverse cardiac events during long-term follow up [J]. Heart, 2010, 96(9):662-667.
[14] Kong JA, Chou ET, Minutelb RM, et al. Safety of single versus multi-vessel angioplasty for patients with acute myocardial infarction and multi-vessel coronary artery disease report from the New York State Angioplasty Registry [J]. Coronary Artery Disease, 2006, 17(1):71-75.
[15] Chen LY, Lennon RJ, Grantham JA, et al. In-hospital and long-term outcomes of multivessel percutaneous coronary revascularization after acute myocardial infarction [J]. Am J Cardiol, 2005, 95(3):349-354.
[16] Katayama N, Horiuchi K, Nakao K, et al. Does percutaneous coronary intervention in non-culprit vessels improve the prognosis of acute myocardial infarction complicated by pump failure? [J]. J Cardiol, 2005, 46(1):1-8.
[17] Serruys PW, Unger F, Sousa JE, et al. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease [J]. N Engl J Med, 2001, 344(15):1117-1124.

相关文章 15

[1]	徐宁宇王磊郝恩魁苏国海. STEMI患者急诊PCI前口服阿托伐他汀对炎症介质及左心室功能的影响[J]. 山东大学学报(医学版), 2209, 47(6): 69-72.
[2]	栗英林,宋道庆,徐忠华. 应用生物信息学方法分析肾透明细胞癌中FKBP11的表达[J]. 山东大学学报 (医学版), 2020, 1(9): 45-51.
[3]	史爽,李娟,米琦,王允山,杜鲁涛,王传新. 胃癌miRNAs预后风险评分模型的构建与应用[J]. 山东大学学报 (医学版), 2020, 1(7): 47-52.
[4]	路璐,孙志钢,张楠. 继发性嗜血细胞综合征1例[J]. 山东大学学报 (医学版), 2020, 1(7): 122-124.
[5]	李星凯,刘战业,姜运峰,李军. 原发性中央型和周围型肺鳞癌临床病理学及预后差异[J]. 山东大学学报（医学版）, 2017, 55(9): 73-78.
[6]	宗帅,肖东杰,刘华,郏雁飞,马晓丽,李焕杰,黎娉,郑燕,汪运山. CSN5在胃癌中的表达及与患者预后的相关性[J]. 山东大学学报（医学版）, 2017, 55(7): 12-16.
[7]	高建步,杨守忠,李玉东,乔崇,张松雨. 南阳地区某医院急性心肌梗死患者院内用药10年变化趋势[J]. 山东大学学报（医学版）, 2017, 55(5): 66-69.
[8]	孙启晶,陈方方,李春晓,张才擎. PNI及HGB评估中晚期非小细胞肺癌患者预后的临床价值[J]. 山东大学学报（医学版）, 2017, 55(4): 55-59.
[9]	董尧,宋亚林,田涛,高建国. 确诊8年未经治疗却无明显进展的阴茎恶性黑色素瘤1例报道[J]. 山东大学学报（医学版）, 2017, 55(3): 125-126.
[10]	林家香,郭子嘉,苏鹏,王晓,郭雅欣,吴晓娟,相磊,周志强, 王妍,崔秀杰,潘爱凤,郭成浩. 致癌蛋白CIP2A在乳腺导管上皮恶变中的作用及预测浸润性导管癌患者预后的能力[J]. 山东大学学报（医学版）, 2017, 55(3): 100-106.
[11]	周兰兰,潘学谊,郭煜. 48例急性混合细胞表型白血病患者的临床特征及预后[J]. 山东大学学报（医学版）, 2017, 55(2): 79-83.
[12]	谈红,孟楠,晋群,苏莉,张夏晓,陈英剑,郝哲,刘晓红. 不同剂量培哚普利对兔急性心肌梗死后内皮祖细胞及心功能的影响[J]. 山东大学学报（医学版）, 2017, 55(2): 55-60.
[13]	张希英,翟春颜,李劲松,韩博. 中国尤文肉瘤患者EZH2蛋白表达与临床病理学参数及预后的关系[J]. 山东大学学报（医学版）, 2017, 55(2): 84-91.
[14]	刘惠苓,王兴文,冯少滨,冯虹,韩俊庆. B类I型清道夫受体的高表达与结肠癌患者预后的相关性[J]. 山东大学学报（医学版）, 2017, 55(10): 84-89.
[15]	王雯,刘尧,龙飞,马卫霞,苏莉莉. 外周血淋巴细胞/单核细胞比值与恶性胸膜间皮瘤患者预后的关系[J]. 山东大学学报（医学版）, 2016, 54(8): 72-77.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed