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.

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