直接经皮冠状动脉介入治疗同期干预非梗死相关动脉对ST段抬高型心肌梗死多支血管病变患者预后的影响

Prognostic impact of direct percutaneous coronary intervention on non-infarction related artery simultaneously on ST-segment elevation myocardial infarction in patients with multivessel disease

目的探讨ST段抬高型心肌梗死(STEMI)多支血管病变直接经皮冠状动脉介入治疗(PCI)成功开通梗死相关血管(IRA)后,同期干预非梗死相关血管(non-IRA)对患者预后的影响。方法选择178例2015年1月至2016年6月于第四军医大学西京医院心血管内科住院治疗的STEMI多支血管病变患者为研究对象,根据non-IRA的干预时机分为一次PCI组(42例)和分期PCI组(136例)。比较两组患者PCI资料和围术期并发症,随访1年,对比两组心功能改善情况和主要不良心血管事件(MACE)发生率。结果与分期PCI组比较,一次PCI组住院时间[(5.5±1.5)d比(9.5±1.5)d,t=3.97,P=0.02]和住院费用[(46 765±20 242)元比(54 884±22 885)元,t=3.88,P=0.04]显著下降;一次PCI组围术期并发症有增加趋势,但差异无统计学意义[6例(14.3%)比13例(9.6%),χ2=0.61,P=0.40];一次PCI组术后1年心功能改善情况优于分期PCI组(左心室射血分数:59.7%±3.4%比55.0%±4.1%,t=3.87,P=0.04),两组MACE发生率的差异无统计学意义[10例(23.8%)比24例(17.6%),χ2=0.79,P=0.38]。结论 STEMI多支血管病变直接PCI同期干预non-IRA显著减少住院时间、住院费用和造影剂用量,更好地改善患者心功能,且未增加围术期并发症和术后发生MACE的风险,在预期成功率较高的情况下可作为STEMI患者直接PCI的一种策略。

Objective To investigate the prognosis of direct percutaneous coronary intervention （PCI）on infarction related artery（IRA） and simultaneously on non-infarct related artery（non-IRA） on ST-segment elevation myocardial infarction （ STEMI） patients with multivessel disease. Methods The 178 patients with STEMI multivessel disease were enrolled into this study in Department of Cardiology,XiJing Hospital of Fourth Military University,from Janurary of 2015 to June of 2016. All patients were divided into multivessel primary PCI group（42 cases）and staged PCI group（136 cases）based on the interventional timing of non-IRA. The data of PCI and the complications during hospitalization were compared between the two groups. Patients were followed up for one year,and the levels of left ventricular ejection fraction（LVEF）and the rates of major adverse cardiovascular events （ MACE ） were compared between the two groups. Results Compared with the staged PCI group,the hospitalization time [（5. 5 ± 1. 5）d vs. （9. 5 ± 1. 5） d, t = 3. 97,P = 0. 02] and hospitalization cost [RMB：（46765 ± 20242）yuan vs. （54884 ± 22885）yuan,t =3. 88,P = 0. 04] were significantly lower in the primary PCI group;however,the perioperative complications increased in primary PCI group, while without statistically difference [ 6 cases （ 14. 3% ） vs. 13 cases （9. 6% ）,χ2 = 0. 61,P = 0. 40]. Meanwhile,incidence of MACE had no significant difference between two groups in one year after PCI [10 cases（23. 8% ） vs. 24 cases（17. 6% ）,χ2 = 0. 79,P = 0. 38] . LVEF in primary PCI group was significant higher compared with staged PCI group（59. 7% ± 3. 4% vs. 55. 0% ± 4. 1% ,t = 3. 87,P = 0. 04）. Conclusions Direct PCI on non-IRA simultaneously on STEMI patients with multivessel disease may reduce hospitalization time and hospitalization expenses, reduce contrast dose, improve LVEF without increase of complications and incident of MACE. Therefore,it could be used as a strategy for STEMI patients by direct PCI if the estimated successful rate is high enough.