非ST段抬高和ST段抬高心肌梗死患者介入结果的比较

Clinical outcomes of patients undergoing percutaneous coronary intervention for ST-elevation type and no-ST-elevation type of acute myocardial infarction

目的 了解接受PCI治疗的ST段抬高心肌梗死（STEMI）和非ST段抬高急性心肌梗死（NSTEMI）患者的近期和长期预后.方法 DESIREⅡ为单中心回顾性注册研究,入选2003年7月1日至2005年9月30日在北京安贞医院接受血运重建治疗的6005例患者,2006年9月1日到11月30日对患者进行电话或门诊随访.入选其中接受PCI的STEMI和NSTEMI患者,通过生存分析比较两组之间的预后情况.不良心脑血管事件（MACCE）包括全因死亡、非致死性心肌梗死、非致死性卒中和再次血运重建.结果 共1009例患者,其中STEMI患者803例,NSTEMI患者206例,NSTEMI的患者高血压病史、陈旧心肌梗死和血运重建病史的比例高,处理多支病变的比例高（43.7%比34.4%,P=0.039）,完全血运重建率高;两组患者的院内死亡率和MACCE发生率及长期预后（1年死亡率分别为96%和98%）差异无统计学意义,对长期预后有影响的因素为LVEF和血肌酐.结论 接受PCI的STEMI和NSTEMI患者临床情况有所差异,但是近期和长期预后相似.

Objective To evaluate the short-term and long-term outcomes of patients with ST-segment elevation myocardial infarction （STEMI） compared with those with non-STEMI after percutaneous coronary intervention （PCI）. Method The DESIRE Ⅱ （Drug-Eluting Stent Impact on Revascularization Ⅱ） was a single-center registered retrospective study of coronary revascularization in our institution between July 2003 and September 2009.Data of demographics, clinical features and revascularization record of STEMI and non-STEMI patients from the DESIRE Ⅱ trial were analyzed. The patients were followed up in OPD or by telephone after discharge. MACCE （major adverse cardiocerebral events） including death, neo-myocardial infarction, stroke and revascularization were recorded. The clinical outcomes of patients of two types were evaluated. Results There were 6005 patients studied with a median follow-up of 566 days. A total of 1009 STEMI and non-STEMI patients were analyzed. The patients with non-STEMI （ n = 206） had higher prevalence of hypertension and history of higher frequency of myocardial infarction as well as revascularization compared with patients with STEMI （ n = 803）. The patients with non-STEMI had higher ratio of treatment for multivessel disease （43.7% vs. 34.4%, P = 0.039）. There were no significant differences in in-hospital mortality and long-term outcomes （one year survival rate： 96% vs. 98%）between patients with STEMI and non-STEMI. The predictors of 1-year mortality were LVEF and blood creatine.Conclusions Despite different chnical features, patients with STEMI and non-STEMI after PCI had similar both short-term and long-term outcomes