急性心肌梗死患者梗死相关动脉瘤样扩张的发生率、处理对策和短期预后研究

Incidence,management countermeasures and short-term outcome of infarct related aneurysmal dilatation in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者梗死相关动脉(IRA)瘤样扩张的发生率、处理对策和预测因素。方法研究共入选925例AMI的患者,根据造影结果分为瘤样扩张组(41例)和非瘤样扩张组(884例),比较两组患者基线资料、介入手术相关指标与住院期间短期预后情况,总结该类患者的治疗策略。结果AMI患者IRA瘤样扩张的发生率为4.4%,更多位于IRA的近段为53.7%。瘤样扩张组患者年龄显著低于非瘤样扩张组(52.3±11.岁vs.62.9±10.2岁,P=0.026),男性比例显著高于非瘤样扩张组(82.9%vs.55.0%,P<0.001)。瘤样扩张组患者高血栓负荷比例(58.5%vs.33.7%,P=0.002)、行血栓抽吸术比例(68.3%vs.41.0%,P=0.001)、慢血流/无复流发生率(14.6%vs.4.8%,P=0.016)显著高于非瘤样扩张组,同样瘤样扩张组患者围术期使用替罗非班(75.6%vs.36.8%,P<0.001)和术中冠状动脉(冠脉)内重组人尿激酶原比例(34.1%vs.11.1%,P<0.001)显著高于非瘤样扩张组。住院期间两组患者在主要不良心脑血管事件(MACCE)方面无显著差异(P>0.05)。结论IRA合并瘤样扩张患者具有更高的血栓负荷,更需行血栓抽吸术,但其预后与不合并瘤样扩张AMI相似。

Objective To investigate the incidence,management countermeasures and predictors of aneurysmal dilatation of the infarct related artery(IRA)in patients with acute myocardial infarction(AMI).Methods A total of 925 patients with AMI were enrolled and divided into two groups based on the angiographic findings:the neoplastic expansion group(41 patients)and the non neoplastic expansion group(884 patients).We compared the baseline data,the indexes related to interventional procedures,and the short-term outcomes during hospitalization between the two groups and summarized the treatment strategies for this group of patients.Results The incidence of IRA neoplasia expansion in AMI patients was 4.4%,and more located in the proximal segment of IRA was 53.7%.Patients in the neoplastic expansion group were significantly younger than those in the non neoplastic expansion group(52.3±11.0 vs.62.9±10.2 years,P=0.026)and had a significantly higher proportion of males(82.9%vs.55.0%,P<0.001).The proportion of patients with high thrombus burden(58.5%vs.33.7%,P=0.002),the proportion who underwent thrombus aspiration(68.3%vs.41.0%,P=0.001),and the incidence of slow flow/no reflow(14.6%vs.4.8%,P=0.016)were significantly higher in the tumor mass expansion group than in the non tumor mass expansion group,as was the perioperative use of tirofiban in patients with tumor mass expansion(75.6%vs.36.8%,P<0.001)and the proportion of intraoperative intracoronary recombinant human urokininogen(34.1%vs.11.1%,P<0.001)were significantly higher in the myectomy group than in the nonmyectomy group.There was no significant difference between the two groups in major adverse cardiovascular or cerebrovascular events(MACCE)during hospitalization(P>0.05).Conclusion Patients with IRA complicated by neoplasia had a higher thrombus burden and more required thrombus aspiration,but their prognosis was similar to that of AMI without neoplasia expansion.