急性ST段抬高心肌梗死患者非梗死相关血管慢性闭塞病变开通对临床预后的影响

The effect of chronic total occlusion staged revascularization in the non-IRA in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

目的：探讨接受急诊冠状动脉介入治疗（PCI）的急性ST段抬高心肌梗死（STEMI）患者非梗死相关血管慢性完全闭塞病变（non-IRA-CTO）,择期介入开通的临床预后影响。方法：对我院急诊科2010年1月至2014年6月,行急诊PCI的患者进行筛选,符合入组标准的STEMI合并non-IRA-CTO的共115例患者,择期non-IRA-CTO开通组39（33.9%）例患者,未开通组（包括介入失败及未介入手术）76例患者。记录患者一般临床资料、药物使用情况、超声心动图及化验检查结果等,收集并阅读介入治疗光盘及手术记录等资料,电话随访1年内主要心血管不良事件（MACE）发生情况,MACE事件包括心源性死亡、再次血运重建、心肌梗死、严重出血及脑卒中。结果：开通组患者术后1个月射血分数较术前显著改善[（53.29±7.24）vs.（57.55±7.89）%,P〈0.05]。开通组1年内MACE事件发生3例（7.7%）,未开通组为30例（39.5%）,差异有统计学意义（P〈0.001）;其中,开通组无心源性死亡患者,后组为7例（9.2%）,差异有统计学意义（P〈0.05）;主要MACE事件（47.8%vs.35.8%,P=0.209）及心源性死亡（4.3%vs.11.3%,P=0.430）在介入开通失败组和未行介入开通手术组间无统计学差异。多元Cox回归分析证实,择期CTO开通（HR=0.219,95%CI 0.066-0.731,P〈0.05）是患者1年无MACE事件的独立预测因素。结论：择期介入开通non-IRA-CTO可以增加接受急诊PCI的STEMI患者术后1个月的射血分数,减少患者1年的MACE事件,改善患者的临床预后。

Objective： Patients with ST-segment elevation myocardial infarction （STEMI） and suffering a chronic total occlusion （CTO） in the non-infarct-related artery （non-IRA） were likely to go through a nega- tive prognosis. We investigated the prognosis of the successful staged revascularization for a CTO in the non- IRA of patients with STEMI undergoing primary percutaneous coronary intervention （p-PCI）. Methods： TA total of 115 patients with STEMI who underwent p-PCI and co-existed a CTO in the non-IRA were included in the study, 39 patients achieved successful revascularizations for a CTO in the non-IRA. The mortality and major adverse cardiac events （MACE） of patients were researched during 1-year follow-up. Results： Patients who did not attempt or failed staged revascularizations remained a higher possibility to experience acute myocardial in- farction （7.7% vs. 26. 3%, P 〈0. 01 ） and PC I in the past （5.1% vs. 18.4%, P 〈 0. 01 ）, compared with those who achieved successful staged revascularization. The left ventricular eject fraction （LVEF） of patients with successful staged revascularization （53.29 ± 7.24） % vs. （ 57.55 ± 7.89 ） %, P 〈 0. 05 ） was improved.Patients who received successful staged revascularization have significantly lower mortality compared with those who did not attempt and failed staged revascularization. No statistical difference of mortality （4. 3% vs. 11.3%, P =0. 430） and MACE （47.8% vs. 35.8%, P =0. 209） was observed between patients with failed procedure and patients who skipped the procedure. Muhivariable analysis showed that successful revascularization （HR = 0. 219, 95% CI 0.066 - 0. 731, P 〈 0. 05 ） was an independent predictor of patients for 1-year MACE-free survival. Conclusion： Successful staged revascularization for a CTO in the non-IRA is associated with improved LVEF and better clinical outcomes in patients with STEMI undergoing p-PCI.