急性ST段抬高心肌梗死患者多支病变血运重建治疗策略的临床研究

The Study of Acute ST Element Myocaidial Infarction in Patients with Multivessel Disease Invasive Revascularization Strategy

目的:分析急性ST段抬高心肌梗死(acute ST segmentelevation myocardial infarction,STEMI)伴多支血管病变行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的策略,制定患者血运重建时机及最佳方案。方法:收集2008.10-2012.10期间急性ST段抬高心肌梗死伴多支血管病变行急诊PCI治疗患者资料,其中仅行罪犯血管PCI治疗组162例,多支血管PCI治疗组50例、阶段PCI治疗组112例,分析比较各组间短期(3个月)死亡率和1年、2年、3年死亡率及主要心血管事件(major cardiovascularevents,MACE)发生率。结果:①多支血管PCI组较罪犯血管PCI组有更高的短期死亡率(4.0%vs 2.5%,P<0.05),但其降低MACE发生率(12.0%vs 15.4%,P<0.05);②阶段PCI组较罪犯血管PCI组有更低的死亡率(短期和1年、2年、3年死亡率均P<0.05)及MACE发生率(11.6%vs 15.4%,P<0.05);③多支血管PCI组较阶段PCI组有更高的短期死亡率(4.0%vsl.8%,P<0.05),长期随访无明显不同(6.0%vs 5.4%,P>0.05);MACE的发生率无明显差异(12.0%vs 11.6%,P>0.05)。结论:当血流动力学稳定时,合并多支血管病变的急性ST段抬高心肌梗死仅对罪犯血管行PCI,随后行阶段PCI处理非梗死病变血管,这一策略能显著改善患者的临床预后。

Objectives： To analyze the patient of acute ST-segment elevation myocardial infarction with multivessel disease who underwent emergency percutaneous coronary intervention, explore the best treatment timing of revascularization and the best solution. Methods： A total of 324 acute ST-segment elevation myocardial infarction with multivessel disease underwent emergency PCI were collected between October 2008 and October 2010, of which 162 underwent culprit-only PCI, 50 multivessel PCI during the index procedure, ll2 had a staged PCI, short-term （within three months） mortality and mortality in 1-year, 2-year, 3-year and major cardiovascular events （MACE） were analyzed. Results： Multivessel PCI was associated with an increased short-term mortality, but it reduced the incidence of revascularization and reinfarction in long-term as compared to culprit-only PCI; staged PCI was associate with a lower short- or long-term mortality or MACE as compared to a culprit-only PCI; multivessel PCI was associated with a higher short-term mortality as compared to a staged PCI; there are no significant difference was found in terms of long-term mortality and the incidence of target vessel revascularization or reinfarction. Conclusions： Our study support the current guidelines recommendation to perform culprit-only PCI in ST-segment elevation myocardial infarction patients with multivessel disease without hemodynamic compromise, followed by a staged PCI of non infarct-related significant lesions.