处理IRA非相关病变对急性心肌梗死病人疗效影响

EFFECT OF TREATMENT OF NON-INFARCT-RELATED ARTERY LESIONS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

目的探讨处理梗死相关血管(IRA)的非梗死病变对ST段抬高性心肌梗死(STEMI)病人无复流现象及近期预后的影响。方法选择2007年1月—2011年6月我院心内科收治的急诊冠状动脉介入治疗STEMI病人,IRA有两处或两处以上病变的病人共196例,随机分为只处理梗死相关病变组为A组(86例),同时处理梗死相关和非相关病变组为B组(110例)。观察术后TIMI分级、TIMI心肌灌注分级(TMP分级)、心电图ST段下降幅度、心肌损伤标记物峰值及出院时超声心动图心功能指标和住院期间主要不良事件(MACE)的发生率。结果A组术后TIMI 3级血流、TMP 3级血流的发生率分别为95.3%和79.7%,B组分别为87.3%和64.5%,A组显著高于B组(χ~2=17.460、3.786,P均<0.05)。A组ST段下降幅度明显大于B组(t=1.572,P<0.05)。A组病人的肌酸磷酸激酶同工酶峰和肌钙蛋白T峰值分别为(193.3±126.3)U/L和(0.82±0.32)ng/L,B组分别为(268.6±146.3)U/L和(1.20±0.56)ng/L,A组明显低于B组(t=-6.654、-6.848,P<0.05、0.01)。出院时A组与B组左心室射血分数分别为(59.3±9.2)%和(50.2±11.2)%,A组明显高于B组(t=4.666,P<0.05),A组与B组左心室收缩末内径分别为(50.5±4.5)和(56.2±3.6)mm,左心室舒张末内径分别为(30.2±2.8)和(38.2±4.3)mm,A组均明显低于B组(t=-3.383、-4.361,P<0.05),A组住院期间MACE的发生率(8.14%)明显低于B组(18.18%)(χ~2=4.098,P<0.05)。结论 STEMI病人行急诊冠状动脉介入治疗时,同时处理梗死血管的非梗死相关病变,反而更易引起无复流现象发生,影响左心室功能的恢复,增加住院期间MACE发生。

Objective To investigate the effect of the treatment of non-infarct-related artery（IRA）lesions on no-reflow phenomenon and short-term prognosis in patients with ST-elevation myocardial infarction（STEMI）. Methods A total of 196 STEMI patients with two or more IRA lesions who were treated with percutaneous coronary intervention（PCI）by our Cardiology Department from January 2007 to June 2011 were randomly divided into group A（treatment of IRA lesions alone,86 cases）and group B（treatment of both IRA and non-IRA lesions,110 cases）.Observations were performed on clinical indices,including postoperative thrombolysis in myocardial infarction（TIMI）and TIMI myocardial perfusion（TMP）grades,decline degree of ST segment on electrocardiogram,peak values of myocardial injury markers,echocardiographic indices of cardiac function at discharge,and incidence of in-hospital major adverse cardiac events（MACE）. Results Compared with group B,group A had significantly higher incidence rates of postoperative TIMI 3 and TMP 3 flow（87.3% vs 95.3%,χ~2=17.460,P0.05;64.5% vs 79.7%,χ~2=3.786,P0.05）.The decline degree of ST segment in group A was significantly higher than that in group B（t=1.572,P0.05）.Group A had significantly lower peak values of creatine phosphokinase isoenzyme and troponin T than group B（193.3±126.3）U/L vs（268.6±146.3）U/L（t=-6.654,P0.05）;（0.82±0.32）ng/L vs（1.20±0.56）ng/L（t=-6.848,P0.01）.Left ventricular ejection fraction at discharge in group A was significantly higher than that in group B（59.3±9.2）% vs（50.2±11.2）%（t=4.666,P0.05）.Compared with group B,group A had significantly lower left ventricular end-systolic diameter and left ventricular end-diastolic diameter at discharge（56.2±3.6）mm vs（50.5±4.5）mm（t=-3.383,P0.05）;（38.2±4.3）mm vs（30.2±2.8）mm（t=-4.361,P0.05）.Group A also had a significantly lower incidence of in-hospital MACE than group B（8.14% vs18.18%,χ~2=4.098,P0.05）. Conclusion In patients with STEMI undergoing primary PCI,treatment of non-IRA lesions in IRA may be more likely to cause no-reflow phenomenon,have an adverse effect on the recovery of left ventricular function,and increase the incidence of in-hospital MACE.