经皮冠状动脉介入治疗相关性心肌梗死危险因素分析研究

Risk factors analysis of PCI-related myocardial infarction

目的分析经皮冠状动脉介入治疗（PCI）相关性心肌梗死的危险因素。方法选择行择期PCI的患者275例，男性228例（82．9％），女性47例（17．1％），平均年龄（62±9）岁，其中162例（58．9％）患者被诊断为急性冠脉综合征（ACS）。检测患者术后8~12h肌钙蛋白I（cTnI）水平，并依据2007年美国AHA关于PCI相关性心梗的诊断标准将患者分成两组（围术期心肌梗死组和非围术期心肌梗死组），观察两组患者术前临床特征、造影结果、术中相关并发症等与PCI围术期相关性心梗之间的关系。结果19例（6．91％）患者发生围术期心肌梗死。造影结果提示，冠脉多支病变（2，3比1）、血栓病变及术中相关并发症（限制性血管夹层、边支血管闭塞、无复流现象）与PCI围术期心肌梗死发生密切相关（P〈0．05）。结论①冠脉多支病变患者发生围术期心肌梗死的概率高于单支病变患者；②冠脉存在血栓病变易发生围术期心肌梗死；③术中相关并发症的发生与围术期心肌梗死密切相关。

Objective To analyze risk factors of PCI （percutaneous coronary intervention） related myocar- dial infarction and to better guide the clinical treatment. Methods A total of 275 patients undergoing elective PCI were enrolled, including 228 male （82.9%） and 47 female （17.1%）. The average age of patients was （62-9）, and 162 cases （58.9%） patients were diagnosed acute coronary syndrome （ACS）. Troponin I（cTnI） was measured 8- 12 h after the intervention, and all the subjects are divided into 2 groups （periprocedural myocardial infarction group vs non-periprocedural myocardial infarction group）, according to 2007 AHA diagnostic criteria for PCI-ro- lated myocardial infarction. The correlation of clinical features, angiography, operation-related complications and other factors before PCI and perioperative myocardial infarction were observed between the two groups. Results There are 19 cases （6.91%） with perioperative myocardial infarction. Angiographic results suggested coronary mul- tivessel disease （2,3 vs 1 ）, thrombotic lesions and operation-related complications（restrictive vessel dissection, side branch flow occlusion, no-roflow phenomenon） were closely associated with the occurrence of PCI perioperative my- ocardial infarction （P〈0.05）. Conclusion The occurrence of perioperative myocardial infarction in patients with coronary muhivessel disease is more frequent than that of those with single vessel disease. Coronary thrombosis le- sions tend to induce perioperative myocardial infarction, the occurrence of operation-related complications is also closely related to periprocedural myocardial infarction.