多支血管病变的非ST段抬高型心肌梗死患者采用不同血运重建策略远期预后的比较

Comparison in long-term prognosis of different revascularization strategies in patients with non-ST-segment elevation myocardial infarction with multi-vessel lesions

目的对比不同血运重建策略对合并多支血管病变的非ST段抬高型心肌梗死(NSTEMI)患者远期预后的影响。方法回顾性收集延安大学咸阳医院心血管内科于2018~2019年接受非ST段抬高型心肌梗死合并多支血管病变同时行经皮冠状动脉介入治疗(PCI)的患者102例,根据住院期间血运重建策略分为完全血运重建组(43例)及不完全血运重建组(59例),分析比较两组患者的远期预后。结果完全血运重建组年龄、脂蛋白a水平及N末端脑钠肽前体(NT-proBNP)水平较不完全血运重建组低,支架植入数目较不完全血运重建组高(P<0.05)。两组患者中位随访时间为28个月,完全血运重建组随访期间主要不良心血管事件(MACE)发生率为7.0%(3/43),低于不完全血运重建组30.5%(18/59),两组比较差异有统计学意义(P<0.05)。发生MACE与未发生MACE患者Killip分级、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、血红蛋白(HB)水平、脂蛋白a水平、高密度脂蛋白(HDL)水平、NT-proBNP水平、D-二聚体水平及完全血运重建率比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,NT-proBNP水平(OR=1.001,95%CI:1.000~1.001,P=0.002)及血运重建策略(OR=0.247,95%CI:0.064~0.954,P=0.043)是NSTEMI合并多支血管病变患者血运重建后随访期间MACE发生独立危险因素。结论对于合并多支血管病变的NSTEMI患者,行完全血运重建策略是安全有效的,可恢复LVEF值,减少心血管事件发生率,改善患者远期预后;NT-proBNP水平及血运重建策略是MACE事件独立危险因素。

Objective To compare the influence of different revascularization strategies on long-term prognosis in patients with non-ST-segment elevation myocardial infarction(NSTEMI)complicated by multi-vessel lesions(MVD).Methods The patients with NSTEMI complicated by MVD(n=102)undergone PCI were chosen from Xianyang Hospital of Yan`an University from 2018 to 2019.According to revascularization strategies during hospitalization,the patients were divided into complete revascularization group(n=43)and incomplete revascularization group(n=59).The long-term prognosis was analyzed and compared in 2 groups.Results The age,lipoprotein a,N-terminal pro-brain natriuretic peptide(NT-proBNP)were lower,and number of stent implantation was higher in complete revascularization group than those in incomplete revascularization group(P<0.05).The median follow-up time was 28 months in 2 groups.During the follow-up period,the incidence rate of MACE was 7.0%(3/43)in complete revascularization group and 30.5%(18/59)in incomplete revascularization group(P<0.05).The difference in Killip grade,LVEDD,LVEF,hemoglobin,lipoprotein a,HDL,NT-proBNP,D-dimer and rate of complete revascularization had statistical significance between patients with MACE and those without MACE(P<0.05).The results of multi-factor Logistic regression analysis showed that NT-proBNP(OR=1.001,95%CI:1.000~1.001,P=0.002)and revascularization strategies(OR=0.247,95%CI:0.064~0.954,P=0.043)were independent factors of MACE in patients with NSTEMI complicated by MVD during follow-up period after revascularization.Conclusion The complete revascularization strategies are safe and effective in patients with NSTEMI complicated by MVD,which can recover LVEF,reduce incidence rates of cardiovascular events and improve patients’long-term prognosis.The level of NT-proBNP and revascularization strategies are independent risk factors of MACE.