急性心肌梗死冠脉多支病变介入治疗效果分析

Clinical Outcomes of Percutaneous Coronary intervention in patients with Acute Myocardial Infarction with More Branches of Lesion Coronary

目的探讨急性心肌梗死多支病变介入治疗单纯重建犯罪血管，与多支病变同时重建对病人远期预后的影响。方法2001-11～2005-01，我院心内科连续154例急性心肌梗死病例入选，均为冠脉造影多支病变、经过选择性冠脉内支架置入术（PCI）治疗并获得随访的急性心肌梗死患者，将仅接受犯罪血管重建者与多支病变血管支架植入者分为两组，药物治疗相同，各例定期于心血管门诊或电话随访。结果两组一般情况比较无明显差异、随访期内坚持药物治疗、术中长支架使用无明显差异（均P〉0．05）；而犯罪血管干预组糖尿病患者比例明显高、心电图ST段抬高者明显少；术后LVEF〈0．40和血清肌酐升高者比例明显高增高；不稳定心绞痛、心肌梗死、血管重建等心血管事件明显增多（均P〈0．05）；心血管死亡略高，但无统计学差异（P〉0．05），非心血管死亡明显高于多支血管重建组（P〈0．05）。结论急性心肌梗死多支血管病变介入治疗单纯重建犯罪血管者预后较差，非心血管死亡增多，主要为糖尿病肾病的肾功衰竭。

Objective To evaluate the Clinical outcomes of the revascularization in the patients with acute myocardial infarction with more branches of lesion coronary by primary percutaneous coronary intervention （PCI） .Methods From January 2001 to January 2005, 154 patients with acute myocardial infarction with more branches lesion coronary were treated by PCI. 80 of the patients were only treated culprit coronary which induced the acute myocardial infarction by stent implantation, others were treated in all the branches of lesion coronary, before and after PCI all the patients were treated by drugs similarly, months follow- up was made in all the patients. Results There was no significant difference between the two groups in general things before treatment, drugs treatment in follow- up period and long stents implantation; in the group only treated the culprit coronary diabetes mellitus rate was significant higher than the other group, ST segment elevation rate was significant lower,patients with LVEF〈 0.40 and blood creatinine≥ 116μmol/L after PCI were significant more; The cardiac incidences such as unstable angina pectoris,myocardial infarction and coronary artery reconstruction were significant more in the group treated the culprit coronary（all P 〈 0.05） ;Cardiac death in the group treated the culprit coronary slightly more（ P 〉 0.05） ,no- cardiac death was significant more（ P 〈 0.05） . Conclusion The clinical outcomes is poor in the Patient with acute myocardial infarction with more branches lesions coronary only treated the culprit coronary by primary PCI. No- cardiac death rate in the group treated the culprit coronary increased. Major cause of no- cardiac death is nephritic induced by diabetes mellitus.