急性心肌梗死合并多支血管病变患者非梗死相关动脉处理的时机

Treatment timing of non-infarct-related artery in patients with multi-vessel disease and acute myocardial infarction

目的探讨急性心肌梗死（AMI）合并多支血管病变（MVD）患者经皮冠状动脉介入治疗（PCI）开通非梗死相关动脉（Non-IRA）的最佳时机。方法纳入AMI合并MVD患者357例,根据是否干预及干预Non-IRA的时机分为对照组（只干预罪犯血管且未择期开通Non-IRA）（n=117）、MV-PCI组（急诊PCI同时开通Non-IRA）（n=32）、0-7 d组（n=28）（排除MV-PCI患者）、8-30 d组（n=84）、31-60 d组（n=96）,随访2年。比较各组基本临床资料、冠脉造影／PCI情况和2年内主要心血管不良事件（MACE）等。结果院内MACE发生率对照组最低（3.4%）,其次为31-60 d组（4.2%）,MV-PCI组最高（18.8%）（P=0.02）。随访MACE发生率对照组最高（59.8%）（P〈0.01）。累积MACE发生率31-60 d组最低（18.80%）（P〈0.01）。结论 PCI干预非梗死相关动脉能够改善预后;急诊PCI一次性完全血运重建风险较大;心肌梗死后31-60 d为干预AMI患者非梗死相关动脉的较理想时机。

Objective To explore the timing of percutaneous coronary intervention（ PCI） for non-infarct-related artery（ Non-IRA） in patients with acute myocardial infarction（ AMI） and multi-vessel disease（ MVD）. Methods A total of 357 cases of AMI and MVD were divided into 5 groups according to whether and when they underwent PCI for NonIRA： control group（ n = 117,who underwent PCI for culprit vessel only）,MV-PCI group（ n = 32,who underwent PCI simultaneously for both culprit vessel and Non-IRA）,0-7d group（ n = 28,who underwent PCI for Non-IRA within7 day）; 8-30 d group（ n = 84,who underwent PCI for Non-IRA within 8-30 days）,31-60 d group（ n = 96,who underwent PCI for Non-IRA within 31-60 days）. All patients were followed up for 2 years. Clinical characteristics,data collected during surgery and major adverse cardiac event（ MACE） were analyzed. Results The incidence of in-hospital MACE was the highest in the MV-PCI group（ 18. 8%）,the lowest in the control group（ 3. 4%）,and the second lowest in the 31-60 d group（ P = 0. 02）. The incidence of follow-up MACE was the highest in the control group（ 59. 8%）（ P〈0. 01）,and the cumulative rate of MACE was the lowest in the 31-60 d group（ 18. 80%）（ P〈0. 01）.Conclusion PCI of Non-IRA can improve the prognosis. Emergency PCI for simultaneous culprit vessel and Non-IRA is risky. It＇s advisable to choose PCI for Non-IRA within 31-60 days after AMI.