不同治疗方式对于急性同步心脑血管梗死预后的影响

Retrospective analysis of prognosis of simultaneous acute cardio-cerebral infarction with endovascular therapy

目的:比较血管内治疗和单纯抗血小板治疗对于急性同步心脑血管梗死(cardio-cerebral infarction,CCI)的疗效,探索CCI治疗的合理治疗方式。方法:对2016年12月~2019年12月吉林大学中日联谊医院收治的CCI患者进行回顾性分析,按纳入和排除标准,纳入了共39例患者,按治疗方式进行分组,行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)和(或)静脉溶栓治疗者为血管内治疗组,仅应用双联抗血小板治疗者为单纯抗血小板组。主要疗效评价指标为有无再发心肌梗死、再发缺血性脑卒中和心脑源性死亡,主要安全性评价指标为有无出血转化(hemorrhagic transformation,HT)和(或)其他出血事件。结果:血管内治疗较单纯抗血小板治疗可减少心脑源性死亡发生风险(8.3%vs 51.8%,P=0.013<0.05),血管内治疗组的再发心肌梗死率、再发缺血性脑卒中率均为0%(0/12),单纯抗血小板组的再发心肌梗死率、再发缺血性脑卒中率均为3.7%(1/27),组间差异无统计学意义(P>0.05);血管内治疗组的出血转化概率、其他出血事件概率分别为16.7%(2/12)、0%(0/12),单纯抗血小板组的出血转化概率、其他出血事件概率分别为3.7%(1/27)、11.1%(3/27),组间差异无统计学意义(P>0.05)。结论:两种治疗方式对再发心肌梗死和再发缺血性脑卒中发生风险的影响无明显差异,对发生出血转化和其他出血事件风险的影响无明显差异,但血管内治疗可减少心脑源性死亡发生风险。

Objective to compare the efficacy of endovascular therapy and antiplatelet therapy for acute simultaneous acute cardio-cerebral infarction(CCI)and to explore the reasonable treatment of CCI therapy.Method Retrospective analysis was carried out on the CCI patients admitted to China-Japan Union Hospital of Jilin University from December 2016 to December 2019.According to the inclusion and exclusion criteria,39 patients were enrolled.According to the treatment method,the patients with PCI and/or intravenous thrombolysis were the endovascular therapy group,and the patients with dual antiplatelet therapy were the simple antiplatelet group.The main evaluation indexes were recurrent myocardial infarction,recurrent ischemic stroke and cardiovascular and cerebrovascular related deaths.The main safety evaluation indexes were HT and/or other hemorrhagic events.Results endovascular therapy was more effective than antiplatelet therapy to reduce the risk of cardiovascular and cerebrovascular related deaths(8.3%vs 51.8%,P=0.013<0.05),The rates of recurrent myocardial infarction and recurrent ischemic stroke in the endovascular therapy group were 0%respectively(0/12),the rate of recurrent myocardial infarction and recurrent ischemic stroke in the simple antiplatelet group was 3.7%(1/27),there were no statistical differences between the 2 groups(P>0.05).The rate of HT and other hemorrhagic events in the endovascular therapy group were 16.7%(2/12),0%(0/12)respectively.and in the simple antiplatelet group were 3.7%(1/27),11.1%(3/27)respectively,there were no statistical differences between the 2 groups(P>0.05).Conclusion There was no significant difference in the effects of the two treatments on the risk of recurrent myocardial infarction and recurrent ischemic stroke,and no significant difference in the risk of HT and other hemorrhagic events.But endovascular therapy can reduce the risk of cardiovascular and cerebrovascular death.