急性心肌梗死患者非梗死相关血管不同干预方式的对比分析

Comparison of different intervention methods for non infarct related blood vessels in patients with acute myocardial infarction

目的:探讨急性心肌梗死(AMI)合并多支血管病变(MVD)患者非梗死相关血管(non-IRA)不同干预方式的临床效果。方法:选取2013年4月至2015年4月在山东省肥城矿业中心医院治疗的AMI合并MVD患者149例,均给予急诊经皮冠状动脉介入治疗(PCI),按随机数字表法分为A组(n=73)和B组(n=76)。A组给予预防性PCI处理non-IRA,B组仅出现缺血证据后再予PCI处理non-IRA,观察两组治疗情况。结果:两组随访期间阿司匹林、他汀类降脂药、受体阻滞剂、ACEI/ARB和扩血管药物的使用情况比较均无明显差异(均P>0.05);A组再次血运重建率为2.74%,明显低于B组的21.05%(P<0.05);A组随访期间不良心血管事件(MACE)总发生率为26.03%,明显低于B组的47.37%(P<0.05),其中A组复发性心绞痛发生率为21.92%,明显低于B组的39.47%(P<0.05);A组平均无MACE事件生存时间为53.95个月,明显长于B组的44.14个月(P<0.05)。结论:对于AMI合并MVD患者,给予预防性PCI处理non-IRA有较好的临床效果,可减少MACE的发生。

Objective:To investigate the effects of different interventions for non infarct related blood arteries(non-IRA)in patients with acute myocardial infarction(AMI)combined with multiple vessel disease(MVD).Methods:149 patients with AMI combined with MVD treated in our hospital from April 2013 to April 2015 were selected.All patients were given emergency percutaneous coronary intervention(PCI).The patients were randomly divided into group A(n=73)and group B(n=76).Patients in group A were treated with preventive PCI for non-IRA,and patients in group B were treated with PCI for non-IRA only after ischemic evidence.The effectiveness of the two groups was observed and compared.Results:There were no significant difference in the use of aspirin,statins,receptor blockers,ACEI/ARB and vasodilators between groups during the follow-up period(P>0.05).The proportion of revascularization in group A was 2.74%,which was significantly lower than that in group B(21.05%)(P<0.05).The overall incidence of major adverse cardiovascular events(MACE)in group A was 26.03%,which was significantly lower than that in group B(47.37%)(P<0.05).The incidence of recurrent angina in group A was 21.92%,which was lower than that in group B(39.47%)(P<0.05).The average survival time of group A without MACE was 53.95 months,which was longer than that in group B(44.14 months)(P<0.05).Conclusion:For patients with AMI combined with MVD,prophylactic PCI for non-IRA is effective and can reduce the incidence of MACE.