急性心肌梗死术后非梗死相关动脉狭窄的治疗方法探讨

Clinical study of different therapeutic strategies for AMI patients with multivessel disease

目的观察急性心肌梗死多支病变患者急诊经皮冠状动脉介入(PCI)手术开通梗死相关动脉(IRA)狭窄后,剩余非IRA严重狭窄再次PCI或药物治疗对预后的影响。方法选取2002—2006年上海交通大学附属第六人民医院及普陀区中心医院诊治的急性心肌梗死多支病变患者190例,一组(129例)仅对罪犯血管实行了再血管化;另一组(61例)实行分期介入手术达到完全再血管化,随访2组患者预后。结果仅处理罪犯血管组平均年龄高(P<0.05)。随访期间死亡事件发生率高(P<0.05)。在高危患者亚组,完全再血管化组预后好。在低危亚组,两组预后差异无统计学意义。结论对于急性心肌梗死多支病变高危患者,应尽可能对大于70%的狭窄实行完全再血管化。对于非高危且不伴有明显缺血症状的患者对其非IRA病变采用保守治疗可达到与完全再血管化治疗类似的效果。

Objective This study aims to analyze the data of patients with acute myocardial infarction （AMI）with multivessel disease（MVD） after emergent PCI procedure for infarct-related artery （IRA）and also to investigate whether PCI procedure tor severe stenotic non-IRA or drug therapies alone can improve the outcome. Methods A total of 190 patients treated with primary angioplasty for AMI with MVD were divided into 2 groups. Patients of one group underwent percutaneous coronary intervention（ PCI ） of the infarct-related artery （ IRA ） only;patients of another group underwent PCI of the IRA followed by staged, in-hospital PCI of the non-IRA （s）. Follow up the prognosis. Results The average age was higher in the incomplete revascularization group. Compared with multivessel PCI, PCI restricted to the IRA only was associated with higher mortality. In the high-risk subgroups, the MACE rate and mortality was obviously higher in the incomplete revascularization group. But in the low-risk subgroup, no obvious differences of prognosis were found between the two groups. Conclusion For the high-risk patients with AMI multi-vessel disease, a strategy of primary PCI directed at the IRA with staged intervention of the non-IRA is associated with good outcome. In the low-risk patients without objective evidence of residual ischemia, PCI directed at the IRA only could get the similar outcome as the complete revascularization.