老年女性急性ST段抬高型心肌梗死非梗死相关动脉不同干预时机选择的临床研究

Selection of intervention timing for noninfarction-related artery in elderly female acute STEMI patients

目的探讨急诊同期或择期再行PCI对老年女性急性ST段抬高型心肌梗死(STEMI)非梗死相关动脉(non-IRA)的临床疗效及安全性。方法选取2016年1月~2018年6月唐山市工人医院收治的行急诊PCI,且急诊冠状动脉造影提示多支病变的老年女性STEMI患者273例,根据梗死相关动脉(IRA)于急诊处理时non-IRA是否行急诊PCI分为择期组149例和同期组124例。择期组non-IRA 5~10 d处理,同期组non-IRA于急诊PCI时同时处理。比较2组一般临床资料,PCI相关临床指标及不良心血管事件(MACE)发生率等。结果择期组住院时间、KillipⅡ~Ⅳ级、SYNTAX评分、IRA术后TIMI 2级、non-IRA置入支架数、non-IRA复杂病变比例明显高于同期组,KillipⅠ级、IRA术后TIMI 3级比例及急诊造影剂用量明显低于同期组(P<0.05,P<0.01)。2组MACE及造影剂肾病发生率比较,无统计学差异(P>0.05)。治疗前择期组LVEF明显低于同期组[(50.37±4.20)%vs(54.46±6.79)%,P=0.018]。术后1年,2组LVEF明显高于治疗前,左心室舒张末期内径明显低于治疗前(P<0.05),择期组LVEF明显低于同期组[(53.62±4.24)%vs(57.92±5.38)%,P=0.007]。结论对老年女性STEMI多支病变高危患者non-IRA行择期PCI相对安全,对低危患者non-IRA可急诊同期干预。

Objective To study the clinical efficacy and safety of emergency concurrent PCI or selective PCI for noninfarction-related artery(nonIRA)in elderly female acute STEMI patients.Methods Two hundred and seventy-three elderly female STEMI patients with multivessel coronary artery disease diagnosed by emergency coronary angiography in our hospital from January 2016 to June 2018 were divided into selective PCI group(n=149)and concurrent PCI group(n=124).The nonIRA in selective PCI group underwent PCI while that in concurrent PCI group received emergency PCI after 5-10 days of admission.The general clinical data,PCI-related clinical parameters and incidence of MACE were compared between the two groups.Results The hospital stay time was significantly longer,the KillipⅡ-Ⅳ,SYNTAX score,IRA postoperative TIMI 2,ratio of nonIRA complex lesions were significantly higher,the number of implanted stents in nonIRA was significantly larger in selective PCI group than in concurrent PCI group while the KillipⅠ,ratio of postoperative IRA TIMI 3 and emergency contrast dose were significantly lower in selective PCI group than in concurrent PCI group(P<0.05,P<0.01)with no significant difference detected in the incidence of MACE and contrast-induced nephropathy between the two groups(P>0.05).The LVEF was significantly lower in selective PCI group than in concurrent PCI group before treatment(50.37%±4.20%vs 54.46%±6.79%,P=0.018).The LVEF was significantly higher while the LVEDD was significantly shorter in two groups after 1 year of PCI than before PCI(P<0.05).The LVEF was significantly lower in selective PCI group than in concurrent PCI group after 1 year of PCI(53.62%±4.24%vs 57.92%±5.38%,P=0.007).Conclusion Selective PCI is relatively safe for nonIRA in elderly female STEMI patients with high risk multivessel coronary artery disease while emergency concurrent PCI is preferable to nonIRA in elderly female STEMI patients with low risk multivessel coronary artery disease.