急性ST段抬高型心肌梗死合并多支冠状动脉病变血运重建策略研究进展

Research progress on revascularization strategy for acute ST-segment elevation myocardial infarction complicated with multivessel coronary artery disease

急性ST段抬高型心肌梗死(STEMI)合并多支冠状动脉病变比较常见,对患者死亡率及预后产生不良影响。与单支冠状动脉病变相比,多支冠状动脉病变患者临床预后差。随着医学发展以及指南更新,STEMI合并多支冠状动脉病变血运重建策略有了新的变化。对于血流动力学稳定的STEMI患者,急诊经皮冠状动脉介入(PCI)治疗时可同时或另行分期处理非梗死相关动脉;对于血流动力学不稳定的STEMI患者,完全血运重建可能增加手术并发症、心力衰竭恶化、对比剂肾病的风险,急性期仅处理梗死相关动脉(IRA)是合理的。本文就STEMI合并多支冠状动脉病变血运重建策略作一综述。

ST-segment elevation myocardial infarction (STEMI) is commonly complicated with multivessel coronary artery disease (MVD), and this condition often exerts adverse effects on mortality and prognosis. Compared with single coronary artery disease, MVD is usually associated with poor prognosis. With the development of medical science and update of guidelines, the revascularization strategy for STEMI with MVD has changed dramatically. Emergency percutaneous coronary intervention (PCI) can treat non-infarct- related arteries simultaneously or separately by different stages. However, for those STEMI patients with unstable hemodynamics, complete revascularization increases the risk of complications, deterioration of heart failure and contrast-induced nephropathy. It is reasonable to treat infarct related artery (IRA) only in acute stage. This article reviews the revascularization strategies for STEMI complicated with MVD.