直接经皮冠状动脉介入治疗时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影响

Prognostic impact of simultaneous non-IRA intervention in patients with ST-segment elevation myocardial infarction and multivessel disease

目的探讨ST段抬高型心肌梗死(STEMI)多支血管病变患者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。方法选择自2015年1月至2016年6月住院治疗的178例STEMI多支血管病变患者为研究对象,根据干预non-IRA的时机分为多支血管一次PCI组(42例)和分期PCI组(136例)。比较两组患者PCI治疗资料和围术期并发症发生率,对患者随访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。结果两组患者冠状动脉造影病变血管数量、non-IRA分布及狭窄程度比较,差异均无统计学意义(P>0.05)。两组患者发病到球囊扩张、植入支架数比较,差异无统计学意义(P>0.05);一次PCI组患者住院时间[(5.5±1.5)d比(9.5±1.5)d]和住院费用[(46 765±20 242)元比(54 884±22 885)元]较分期PCI组明显降低,组间比较,差异有统计学意义(P<0.05)。一次PCI组围术期并发症发生率较分期PCI组有升高趋势,但组间比较,差异无统计学意义(P>0.05)。患者术后1年,一次PCI组患者左室射血分数[(59.7%±3.4%)比(55.0%±4.1%)]优于分期PCI组,组间比较,差异有统计学意义(P<0.05);两组患者MACE发生率比较,差异均无统计学意义(P>0.05)。结论 STEMI多支血管病变患者PCI同期干预non-IRA可减少住院时间和费用,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。

Objective To investigate the prognosis effect of simultaneous intervention of non-infarct related artery（ non-IRA） in patients with ST-segment elevation myocardial infarction（ STEMI） and multivessel disease. Methods A retrospective study was performed on 178 cases of patients with STEMI and multivessel disease who were admitted from January 2015 to June 2016. According to the time of non-IRA intervention,patients were divided into the one-time PCI group（ 42 cases） and staging PCI group（ 136 cases）. The data of PCI and the complications during hospitalization were compared between the two groups. Patients were followed up for 1 year,the LVEF improvementand major adverse cardiovascularevents（ MACE） were compared between the two groups. Results There was no statistically significant difference in the number of coronary angiography lesions,non-IRA distribution and degree of stenosis in the two groups（ P〉0. 05）. There was no statistically significant difference between the two groups in the incidence of balloon dilatation and number of stent implantation（ P〉0. 05）. The duration of hospital stay in the one-time PCI group [（ 5. 5 ± 1. 5） daysversus（ 9. 5 ±1. 5） days] and hospitalization expense[（ 46 765 ± 20 242） yuan versus（ 54 884 ± 22 885） yuan]was significantly lower than that in the staging PCI group（ P〈0. 05）. The incidence of perioperative complications in one-time PCI group was higher than that in the staging PCI group,while there was no statistically significant difference between the groups（ P〉0. 05）. One year after surgery,the LVEF score of patients in the one-time PCI group[（ 59. 7% ± 3. 4%） versus（ 55. 0% ± 4. 1%） ] was better than that in the staging PCI group（ P〈0. 05）. There was no statistically significant difference in the incidence of MACE between the two groups（ P〉0. 05）. Conclusion Treatment of STEMI patients with multi-vessel disease,simultaneous intervention of non-IRA can reduce hospitalization time and cost,improve cardiac function,and do not increase the risk of perioperative complications and postoperative MACE.