冠状动脉支架置入1年后发生急性心肌梗死患者近期及远期临床结局分析

Analysis of short-term and long-term clinical outcomes in patients with acute myocardial infarction after one year of coronary stent implantation

目的观察冠状动脉支架置入1年后发生急性心肌梗死患者院内及出院1年生存及预后。方法入选2015年1月至2018年2月冠状动脉支架置入1年后发生急性心肌梗死并完成冠状动脉造影患者共329例。根据急性心肌梗死靶病变是否与支架相关分组,分为极晚期支架内血栓组(VLST组)240例,冠状动脉原发原位病变组(denovo组)89例,对比两组患者住院期间及出院1年的终点事件。主要研究终点包括心源性死亡,再发急性心肌梗死。次要研究终点包括靶病变血运重建(TLR),再次支架内血栓,心力衰竭,卒中。结果冠状动脉支架置入1年后发生急性心肌梗死患者约72.9%(绝对值240/329)由极晚期支架内血栓引起。住院期间主要研究终点及次要研究终点两组无显著差异(3.3%比3.4%,P=0.987)(5.4%比4.5%,P=0.956)。平均随访1年,主要研究终点两组无显著差异。次要研究终点事件及TLR发生率VLST组高于denovo组(16.3%比6.7%,P=0.026)(9.6%比2.2%,P=0.026)。Kaplan-Meier生存分析表明1年累积无主要终点事件生存率两组差异无统计学意义(P=0.124),1年累积无次要终点事件生存率VLST组低于denovo组(P=0.004)。COX回归分析表明心功能≥Ⅲ级(Killip′s),VLST是冠状动脉支架置入1年后发生急性心肌梗死患者发生终点事件的独立危险因素,术后血流TIMI 3级是其独立保护性因素。结论与原发原位急性心肌梗死比较,VLST致急性心肌梗死患者院内终点事件无显著差异。1年随访发现VLST致急性心肌梗死患者预后较差,接受靶病变血运重建比例较高。合并心功能≥Ⅲ级(Killip′s)及VLST患者预后较差,术后血流TIMI 3级患者预后较好。

Objective To observe in-hospital and 1-year prognosis of patients with acute myocardial infarction after one year of coronary stent implantation.Methods From January 2015 to February 2018,329 patients with acute myocardial infarction(AMI)after 1 year of coronary artery stent implantation were enrolled and received coronary angiography.These patients were divided into two groups(very late stent thrombosis(VLST)group and denovo group)according to whether the occurrence of acute myocardial infarction was due to stent thrombosis(ST),and in-hospital and long-term(1 year)outcomes were compared between the two groups.The primary end points included cardiac death and recurrent acute myocardial infarction.The secondary study end points included target lesion revascularization(TLR),re-stent thrombosis,heart failure,and stroke.Results In total,72.9%of patients with AMI after one year of coronary stent implantation were caused by VLST.There were no significant differences of both primary and secondary end-point events between the two groups during in-hospital period(3.3%vs 3.4%,P=0.987;5.4%vs 4.5%,P=0.956).After a mean follow-up of 1 year,there were no significant differences of the primary end-point events between the two groups.The secondary end-point events and TLR incidence were higher in the VLST group(16.3%vs 6.7%,P=0.026;9.6%vs 2.2%,P=0.026).Kaplan and Meier survival analysis showed that there were no significant differences of the 1-year cumulative non-primary and non-secondary end-point survival rates between the two groups(P=0.124 and 0.004,respectively).COX regression analysis showed that heart function≥Ⅲlevel(Killip’s)and VLST were independent predictive risk factors for end-point events,while postprocedural thrombolysis in myocardial infarction(TIMI)flow grade 3 was an independent protective factor.Conclusion In-hospital end points show no significant differences between VLST and denovo groups patients.However,the VLST group patients have a poor prognosis and a higher proportion of TLR after 1 year follow-up.The patients with heart function≥Ⅲlevel(Killip’s)or VLST have a poor prognosis,while the patients with postprocedural TIMI flow grade 3 have a good prognosis.