冠状动脉前降支靶病变及临界病变部位同期支架置入治疗急性ST段抬高型心肌梗死

Feasibility of simultaneous stent implantation on target lesion and borderline lesion of anterior descending coronary artery in treatment of acute ST segment elevation myocardial infarction

目的观察冠状动脉(简称冠脉)前降支靶病变及临界病变部位同期支架置入治疗急性ST段抬高型心肌梗死(STEMI)的可行性。方法 76例急性STEMI患者,均接受急诊经皮冠脉介入(PCI)术治疗,冠脉造影证实"罪犯"血管为前降支且靶病变以外存在临界病变,用单双日法将患者分为观察组37例和对照组39例。观察组PCI术中同时对靶病变和临界病变行支架置入治疗,对照组仅对靶病变行支架置入治疗。计算并比较两组患者PCI术中并发症发生率、住院期间心血管事件发生率及1年内主要心血管不良事件(MACE)的发生率;检测并比较两组患者术后第1、5、10天的血浆B型利钠肽(BNP)水平,术后第1、6、12个月的左心室舒张末期内径(LVDd)及左心室射血分数(LVEF)。结果与对照组相比,观察组PCI术中并发症发生率、住院期间心血管事件发生率高(P均<0.05)。与对照组相比,观察组术后第1、5、10天血浆BNP水平高(P均<0.05)。观察组与对照组术后1、6、12个月的LVDd及LVEF比较,差异无统计学意义。观察组与对照组1年内MACE发生率比较,差异无统计学意义。结论急诊PCI术中同时行支架置入干预前降支内靶病变及临界病变治疗急性STEMI,与仅行靶病变支架置入相比,增加了患者术中并发症发生率及住院期间心血管事件发生率,且不利于患者近期心功能的恢复,对患者远期心功能及MACE无显著影响。

Objective To investigate the feasibility of using simultaneous stent implantation on target lesion and borderline lesion of anterior descending coronary artery in treatment of acute ST segment elevation myocardial infarction（ STEMI）. Methods Seventy-six acute STEMI patients with anterior descending coronary artery as culprit artery were treated by primary percutaneous coronary intervention（ PCI）,and there was a borderline lesion beyond the target lesion in the culprit artery. The patients were randomly divided into two groups： the observation group（ n = 37） and the control group（ n =39）. Patients in the observation group were performed with simultaneous stent implantation on both target and borderline lesions in the culprit artery,while in the control group,they were performed with stent implantation on target lesion only. We calculated and compared the incidence of complication during PCI operation,the incidence of cardiovascular events in hospitalization period and the incidence of major adverse cardiac events（ MACE） within 1 year in both groups. Meanwhile,we detected and compared the levels of B-type natriuretic peptide（ BNP） in plasma in both groups on day 1,5 and 10 after the different interventions as well as the left ventricular end-diastolic dimension（ LVDd） and left ventricular ejective fraction（ LVEF） in both groups in 1,6 and 12 months after the operation. Results Compared with the control group,the incidence of complication during PCI operation and the incidence of cardiovascular events in hospitalization period were significantly higher in the observation group（ all P〈0. 05）; and the levels of BNP on day 1,5 and 10 after the different interventions were significantly higher in the observation group（ all P〈0. 05）. There was no statistically significant difference in LVDd and LVEF in 1,6 and 12 months after the operation between the observation group and control group; and there was no statistically significant difference in MACE within 1 year between the observation group and control group. Conclusions Simultaneous stent implantation on both target and borderline lesion in anterior descending coronary artery of acute STEMI increased the incidence of complication during primary PCI operation and the incidence of cardiovascular events in hospitalization period as compared with that of stent implantation on target lesion only,and it was not conducive to the recent recovery of cardiac function in patients,and had no significant effect on long-term cardiac function and MACE of patients.