不同处理方式对并发多支血管病变非ST段抬高型心肌梗死患者远期预后的影响及相关因素分析

Effects of different treatments on long-term prognosis of patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease and analysis of the factors related to them

目的比较非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)并发多支血管病变仅处理"罪犯"血管(culprit-only revascularization,COR)和一次性完全血运重建(one-time complete revascularization,CR)两种不同的处理方式对患者远期预后的影响及相关因素分析。方法入选2016年1月至2018年5月入住河北省人民医院心血管内科的患者140例,根据NSTEMI并发多支血管病变处理方式的不同,失访及资料不完整10例,将患者分为COR组(n=95)和CR组(n=35)。收集入选患者的性别、年龄、吸烟史、原发性高血压(高血压)、糖尿病、生化指标、超声心动图指标、介入手术相关指标等基线资料,比较两种不同的处理方式对NSTEMI并发多支血管病变患者远期预后的影响及相关因素分析。结果 NSTEMI并发多支血管病变患者随访时间为11.25(5.38~15.13)个月。CR组与COR组复合终点(全因死亡,再发心肌梗死,再次血运重建,心绞痛住院)比较,差异有统计学意义(8.57%vs. 6.32%,P=0.035);CR组与COR组次要终点(心绞痛复发,出血,心律失常,心力衰竭住院,脑卒中)比较,差异仍有统计学意义(48.58%vs. 23.15%,P=0.031)。二项多变量Logistic回归分析显示,在复合终点事件中,首次医疗接触时间(FMC)(β=0.005,OR=1.005,95%CI:1.000~1.010,P=0.043)是影响NSTEMI并发多支血管病变患者发生复合终点事件的危险因素;然而,在次要终点事件中,COR策略(β=-0.614,OR=0.541,95%CI:0.297~0.986,P=0.045)是影响NSTEMI并发多支血管病变患者发生次要终点事件的保护因素,可改善次要终点事件的发生。结论对于NSTEMI并发多支血管病变患者,COR可能为一个理想的策略,可改善其远期预后,是其发生次要终点事件的保护因素;首次医疗接触时间是其主要终点事件的危险因素。

Objectives The compare effects of only dealing with culprit-only revascularization(COR)and one-time complete revascularization(CR)treatments on long-term prognosis of patients with non-ST-segment elevation myocardial infarction(NSTEMI)and multivessel coronary artery disease and analysis of the factors related to them. Methods A total of 140 patients treated in Hebei General Hospital,North China University of Science and Technology from January 2016 to May 2018 were enrolled. We excluded the patients who lost a phone interview. According to different treatments of NSTEMI with multivessel coronary artery disease,the patients were divided into COR group(n=95)and CR group(n=35)after excluding the patients who were loss to follow-up. Basic clinical information including gender,age,smoking history,essential hypertension,diabetes mellitu,biochemical indicators,echocardiography and interventional procedure indexes were collected. The effects of two different treatments on the long-term prognosis of patients with NSTEMI and multivessel coronary artery disease were compared. Results The average follow-up duration of patients with NSTEMI and multivessel coronary artery disease was 11.25 months. Compound end point(all-cause death,recurrence of myocardial infarction,target vessel revascularization,angina caused hospitalization)of CR group was significantly higher than that of COR group(8.57% vs. 6.32 %,P=0.035). Secondary end point(angina recurrence,bleeding,arrhythmia,heart failure-caused hospitalization,stroke)of CR group was also significantly higher than that of COR group(48.58% vs. 23.15%,P=0.031). According to the principle of multivariate Logistic regression analysis,we found that first medical contact(FMC)time(β=0.005,OR=1.005,95%CI:1.000-1.010,P=0.043)was a risk factor for the occurrence of compound end point with NSTEMI and multivessel coronary artery disease. However,COR(β=-0.614,OR=0.541,95%CI:0.297-0.986,P=0.045)was a protective factor for the secondary end point,reducing the occurrence of the secondary end point. Conclusions COR may be an ideal strategy for NSTEMI patients with multivessel coronary artery disease,and it may be a protective factor for these patients in secondary endpoint events;FMC time may be a risk factor for these patients in primary end point.