急性心肌梗死患者非梗死相关血管PCI的时机对预后的影响

Effects of time point of arranged secondary percutaneous coronary intervention for non-infarct related artery on prognosis in acute myocardial infarction patients

目的研究急性心肌梗死(AMI)多支血管病变的冠心病患者非梗死相关血管(non-IRA)行计划内二次经皮冠状动脉介入治疗(PCI)的时机对左心功能和预后的影响。方法纳入2013年1月至2017年12月在江苏大学附属医院心内科住院,并经选择性冠状动脉造影证实为冠状动脉多支血管病变且行计划内二次PCI术的AMI患者共386例,其中ST段抬高型心肌梗死(STEMI)组218例,非ST段抬高型心肌梗死(NSTEMI)组168例。分别随机选择不同时机对non-IRA进行计划内二次PCI术,每组再根据二次PCI术间隔的时间(T)分为3个亚组:A组:3天≤T<7天,B组:7天≤T≤10天,C组:T>10天。随访观察和比较上述不同时机行二次PCI术患者的中远期预后,包括左心功能、主要不良心血管事件(MACE)及生存率。结果(1)218例STEMI患者,平均随访(42.54±15.60)月,其A组、B组、C组左心室射血分数增加值(ΔLVEF)分别为2.91%±0.79%、0.30%±0.58%、-0.12%±1.93%,差异具有统计学意义(P=0.026)。总的累积无事件生存率3个亚组分别为90.0%、67.2%和41.2%,差异有统计学意义(P<0.01)。二次PCI术后生存率A组高于B组及C组(P=0.021,P=0.010)。(2)168例NSTEMI患者,平均随访(39.85±16.19)月,其A组、B组、C组的ΔLVEF分别为1.73%±0.50%、0.10%±0.71%、-1.57%±2.00%,差异具有统计学意义(P=0.039)。总的累积无事件生存率3个亚组分别为87.0%、59.7%和28.6%,差异有统计学意义(P<0.01)。二次PCI术后生存率A组高于B组及C组(P=0.032,P=0.012)。结论对多支血管病变AMI患者non-IRA行二次PCI的时机可影响患者的左心室功能和累积无事件生存率。

Aim To investigate the effects of different timing of arranged secondary percutaneous coronary intervention(PCI)for non-infarct related artery(non-IRA)on left ventricular function and prognosis in acute myocardial infarction(AMI)patients with coronary artery multivessel disease.Methods From January 2013 to December 2017,386 AMI patients were admitted to the Department of Cardiology,Affiliated Hospital of Jiangsu University,who were confirmed by selective coronary angiography to have coronary artery multivessel disease and underwent planned secondary PCI.Of these patients,218 were in the ST-segment elevation myocardial infarction(STEMI)group and 168 in the non-ST-segment elevation myocardial infarction(NSTEMI)group.Randomly choosing different time to perform secondary PCI on non-IRA,each group was divided into three subgroups according to the time interval(T)between two PCI operations:A group:3 days≤T<7 days;B group:7 days≤T≤10 days;C group:T>10 days.The long-term and medium-term prognosis of the patients who underwent planned secondary PCI at different time were observed and compared,including left ventricular function,major adverse cardiovascular event(MACE)and survival rate.Results(1)218 patients with STEMI were followed up for an average of(42.54±15.60)months.The increased value of left ventricular ejection fraction(ΔLVEF)in A group,B group and C group was 2.91%±0.79%,0.30%±0.58%and-0.12%±1.93%,respectively;The difference was statistically significant(P=0.026).The total cumulative event-free survival rate of three subgroups were 90.0%,67.2%and 41.2%,respectively,and the difference was statistically significant(P<0.01).Survival rate after secondary PCI in A group was higher than that in B group and C group(P=0.021,P=0.010).(2)168 patients with NSTEMI were followed up for an average of(39.85±16.19)months.TheΔLVEF of A group,B group and C group were 1.73%±0.50%,0.10%±0.71%and-1.57%±2.00%,respectively;The difference was statistically significant(P=0.039).The total cumulative event-free survival rate of three subgroups were 87.0%,59.7%and 28.6%,respectively,and the difference was statistically significant(P<0.01).Survival rate after secondary PCI in A group was higher than that in B group and C group(P=0.032,P=0.012).Conclusion Timing of secondary PCI for non-IRA may affect left ventricular function and cumulative event-free survival rate in AMI patients with multivessel disease.