摘要
目的:研究血运重建策略对左主干病变所致急性心肌梗死(AMI)患者预后的影响。方法:以2017年10月—2020年10月因左主干病变所致AMI的90例患者为研究对象,将其分为保守治疗组(19例)、经皮冠状动脉(冠脉)介入治疗(PCI)组(47例)和冠脉旁路移植(CABG)组(24例)。统计患者基本临床资料及冠脉病变特点。自发病后进行随访,统计全因死亡率及不良事件情况。结果:保守治疗组年龄高于PCI组和CABG组(P<0.05)。PCI组患者血栓性病变比例和住院使用IABP的比例高于保守治疗组和CABG组(P<0.05)。CABG组患者GRACE评分低于保守治疗组和PCI组(P<0.05)。PCI组及CABG组不良事件发生率低于保守治疗组,生存率高于保守治疗组(P<0.05),PCI组与CABG组不良事件发生率及生存率比较差异无统计学意义。Cox回归分析可见PCI(HR=0.335,95%CI:0.163~0.689)及CABG(HR=0.297,95%CI:0.123~0.717)较保守治疗,均可降低患者的不良事件发生率。PCI(HR=0.405,95%CI:0.194~0.847)及CABG(HR=0.173,95%CI:0.056~0.535)可减少全因死亡率。结论:PCI及CABG与保守治疗比较,均可改善左主干病变所致AMI患者预后,提高生存率。
Objective:To investigate the prognosis of different strategies of revascularization in patients with acute myocardial infarction(AMI)caused by left main coronary artery lesions.Methods:A total of 90 patients with AMI due to left main coronary artery lesions from October 2017 to October 2020 were selected as the subjects.All the patients were divided into three groups,conservative treatment group(n=19),percutaneous coronary intervention(PCI)group(n=47),and coronary artery bypass graft group(CABG)group(n=24).The baseline clinical data and characteristics of coronary artery lesions of the patients were analyzed.All-cause mortality and adverse events after AMI were followed up and investigated.Results:The age of the conservative treatment group was higher than that of the PCI group and CABG group(P<0.05).The rates of thrombotic lesions and using IABP during hospitalization in the PCI group were higher than that in the conservative treatment group and CABG group(P<0.05).GRACE scores in CABG group were lower than that in the conservative treatment group and PCI group(P<0.05).The incidence of adverse events in PCI group and CABG group was lower than that in the conservative treatment group,but the survival rate was higher than the conservative treatment group(P<0.05).There was no significant difference in the incidence of adverse events and survival rate between the PCI group and CABG group.Cox regression analysis showed that PCI(HR=0.335,95%CI:0.163-0.689)and CABG(HR=0.297,95%CI:0.123-0.717)both could reduce the incidence of adverse events compared with conservative treatment.Both PCI(HR=0.405,95%CI:0.194-0.847)and CABG(HR=0.173,95%CI:0.056-0.535)could reduce the all-cause mortality.Conclusion:PCI and CABG both could improve the prognosis and survival rate compared with conservative treatment in patients with acute myocardial infarction caused by left main coronary artery lesions.
作者
李海蓬
张健
LI Haipeng;ZHANG Jian(Department of Cardiology,TED A International Cardiovascular Hospital,Tianjin,300457,China)
出处
《临床心血管病杂志》
CAS
北大核心
2022年第4期303-307,共5页
Journal of Clinical Cardiology
关键词
左主干病变
急性心肌梗死
介入治疗
冠状动脉旁路移植术
预后
left main coronary lesions
acute myocardial infarction
percutaneous coronary intervention
coronary artery bypass graft
prognosis