罪犯血管对行分期经皮冠状动脉介入治疗完全血运重建合并多支冠状动脉病变急性ST段抬高型心肌梗死患者预后的预测价值

Predictive value of criminal vessel on prognosis of patients with acute ST-segment elevation myocardial infarction and mutiple coronary arteries lesion who undergo complete revascularization of staging percutaneous coronary intervention

目的探讨罪犯血管对行分期经皮冠状动脉介入治疗(PCI)完全血运重建合并多支冠状动脉病变急性ST段抬高型心肌梗死(STEMI)患者预后的预测价值。方法纳入行分期PCI完全血运重建合并多支冠状动脉病变急性STEMI患者163例,根据罪犯血管不同将其分为左冠状动脉前降支(LAD)组64例、左冠状动脉回旋支(LCX)组32例和右冠状动脉(RCA)组67例。比较3组患者的临床资料,随访其PCI后2年主要不良心脏事件(MACE)和支架内血栓的发生情况,主要研究终点为Kaplan-Meier估计的MACE,并进行组间比较。采用Cox回归模型分析MACE的预测因素。结果3组患者左心室射血分数(LVEF)比较差异有统计学意义,其中LAD组低于RCA组(P<0.05)。3组患者2年预期MACE发生率比较差异有统计学意义(Log-rank P=0.049),其中LAD组患者2年预期MACE发生率高于RCA组(Log-rank P=0.020)。多因素Cox回归分析结果显示,罪犯血管、主动脉球囊反搏、LVEF及胸痛发作时间均为行分期PCI完全血运重建合并多支冠状动脉病变急性STEMI患者PCI后2年MACE发生的独立预测因素(P<0.05)。结论在行分期PCI完全血运重建合并多支冠状动脉病变急性STEMI患者中,罪犯血管为LAD患者2年预期MACE发生率高于罪犯血管为RCA患者,罪犯血管为其PCI后2年MACE发生的独立预测因素。

Objective To explore predictive value of criminal vessel on prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)and mutiple coronary arteries lesion who undergo complete revascularization of staging percutaneous coronary intervention(PCI).Methods A total of 163 patients with acute STEMI and mutiple coronary arteries lesion who underwent complete revascularization of staging PCI were included and divided into left anterior descending coronary artery(LAD)group(64 cases),left circumflex coronary artery(LCX)group(32 cases)and right coronary artery(RCA)group(67 cases)according to different criminal vessel.Clinical data among patients of 3 groups were compared,and the occurrence of major adverse cardiac events(MACE)and stent thrombosis were followed up within 2 years after PCI.Primary study endpoint was Kaplan-Meier estimated MACE and to compare above indexes among 3 groups.Predictive factors of MACE were analyzed by Cox regression model.Results There was significant difference of left ventricular ejection fraction(LVEF)among patients of 3 groups,and LVEF in LAD group was lower than that in RCA group(P<0.05).There was significant difference of incidence of estimated MACE within 2 years among patients of 3 groups(Log-rank P=0.049),and incidence of estimated MACE within 2 years in LAD group was higher than that in RCA group(Log-rank P=0.020).Multivariate Cox regression analysis showed that criminal vessel,aortic balloon counterpulsation,LVEF and onset time of chest pain were independent predictors of MACE within 2 years after PCI in patients with acute STEMI and mutiple coronary arteries lesion who underwent complete revascularization of staging PCI(P<0.05).Conclusion In patients with acute STEMI and mutiple coronary arteries lesion who undergo complete revascularization of staging PCI,the incidence of expect MACE within 2 years in patients whose criminal vessel is LAD is higher than that in patients whose criminal vessel is RCA.Criminal vessel is an independent predictor of MACE 2 years after PCI.