非ST段抬高型心肌梗死患者冠状动脉完全闭塞的发生率及对预后的影响

Incidence of total coronary occlusion and its influence on prognosis in patients with non-ST-segment elevation myocardial infarction

目的观察非ST段抬高型心肌梗死(NSTEMI)患者罪犯血管完全闭塞的分布及对预后的影响。方法选取2014年1月至2017年12月于丹阳市人民医院心内科住院的192例NSTEMI患者为研究对象,根据冠状动脉(冠脉)造影TIMI血流分级结果,分为完全闭塞组(TIMI血流0级,n=30)及非完全闭塞组(TIMI血流1~3级,n=162)。分析NSTEMI患者冠脉完全闭塞的发生率及分布,并评估患者住院期间及出院30 d、90 d、180 d心脏猝死、复发性非致命性心肌梗死、靶血管血运重建及卒中发生率。结果 192例患者中,总共30例(15.6%)罪犯血管完全闭塞,其中前降支5例(16.7%)、回旋支14例(46.7%)和右冠11例(36.7%)。与非完全闭塞组相比,完全闭塞组患者年龄较低,低密度脂蛋白胆固醇(LDL-C)更高,入院时TIMI积分高,差异均有统计学意义(P<0.05)。二元回归分析表明,只有入院时TIMI积分(OR=2.699,95%CI:1.283~5.674,P=0.009)及LDL-C(OR=1.994,95%CI:1.263~3.148,P=0.003)可以作为罪犯血管完全闭塞的独立预测因子。住院期间及30 d完全闭塞组的主要复合终点事件发生率高(P<0.05),但180 d两组之间无统计学差异(P>0.05)。结论 30例(15.6%)NSTEMI患者罪犯血管完全闭塞,180 d两组患者主要心血管终点事件无明显差异,入院时患者TIMI积分及LDL-C水平可以作为冠状动脉完全闭塞的独立预测因子。

Objective To observe the distribution of the total occlusion of culprit vessels and its influence on prognosis in patients with non-ST-segment elevation myocardial infarction(NSTEMI). Methods NSTEMI patients(n=192) were chosen from Department of Cardiology in People’s Hospital of Danyang City from Jan. 2014 to Dec. 2017. All patients were divided, according to flow grading of thrombolysis in myocardial infarction(TIMI), into total occlusion group(TIMI=0, n=30), and non-total occlusion group(TIMI=1-3, n=162). The incidence and distribution of total coronary occlusion were analyzed in NSTEMI patients. The incidence rates of sudden cardiac death, recurrent nonfatal myocardial infarction(MI), target vessel revascularization(TVR) and stroke were reviewed in 2 groups during hospitalization and after discharged from hospital for 30 d, 90 d and 180 d. Results Among 192 patients, 30(15.6%) with total occlusion of culprit vessels, 5(16.7%) with total occlusion of left anterior descending branch coronary artery, 14(46.7%) with total occlusion of left circumflex of coronary artery, and 11(36.7%) with total occlusion of right coronary artery. Compared with non-total occlusion group, the age was younger, the level of low-density lipoprotein-cholesterol(LDL-C) was higher and TIMI integral was higher at hospitalization time in total occlusion group(P<0.05). The results of binary regression analysis showed that only TIMI integral at hospitalization time(OR=2.699, 95%CI:1.283~5.674, P=0.009) and LDL-C(OR=1.994, 95%CI:1.263~3.148, P=0.003) were the independent predictive factors for the total occlusion of culprit vessels. The incidence of major composite endpoint events was higher in total occlusion group during hospitalization and after discharged from hospital for 30 d, but there was no statistical difference between 2 groups after discharged from hospital for 180 d. Conclusion There are 30(15.6%) NSTEMI patients with the total occlusion of culprit vessels, and there is no significant difference in major composite endpoint events between 2 groups after discharged from hospital for 180 d. TIMI integral at hospitalization time and LDL-C level can be taken as the independent predictive factors for total coronary occlusion of coronary artery.