急性心肌梗死患者经皮冠状动脉介入术后多支血管病变治疗策略分析及心脏康复的影响

Analysis of treatment strategies for multi-vessel disease after percutaneous coronary intervention in patients with acute myocardial infarction and the impact on cardiac rehabilitation

目的 探讨急性心肌梗死(AMI)患者经皮冠状动脉介入术后多支血管病变(MVD)的治疗策略及心脏康复对患者预后的影响。方法 收集2020年1月至2022年3月于首都医科大学附属北京积水潭医院住院接受冠状动脉介入术的92例AMI患者的临床资料。记录所有患者的介入手术相关信息。比较同期处理组与二次处理组患者、门诊实施组和居家实施组患者的临床信息、介入术后随访1年结局。结果 92例AMI患者均合并MVD,病变累及冠状动脉2~4支,平均(2.7±0.4)支;51例患者在同次住院期间对所有病变进行了介入治疗(同期处理组),41例患者在介入术后再次住院时治疗了非AMI罪犯血管(二次处理组)。所有患者在第1次介入治疗后均接受了强化他汀治疗和双联抗血小板治疗。43例患者经第1次介入治疗后在门诊接受心脏康复干预(门诊实施组),49例患者遵医嘱自行居家实施康复运动(居家实施组)。同期处理组患者在住院期间植入支架的数量明显多于二次处理组患者,差异有统计学意义(P﹤0.01)。介入术后1年随访结果显示,92例AMI患者中,共死亡14例,其中,同期处理组患者的全因死亡率、心力衰竭的发生率均低于二次处理组患者,门诊实施组患者的全因死亡率、心力衰竭的发生率均低于居家实施组患者,差异均有统计学意义(P﹤0.05)。结论 直接治疗MVD未增加AMI患者病死和心力衰竭的风险,门诊心脏康复可改善AMI患者介入术后1年的预后。

Objective To investigate the treatment strategies for multi-vessel disease(MVD)after percutaneous coronary intervention in patients with acute myocardial infarction(AMI)and the impact on cardiac rehabilitation.Method Clinical data of 92 AMI patients treated with percutaneous coronary intervention in the Beijing Jishuitan Hospital,Capital Medical University from January 2020 to March 2022 were collected.Information about interventional surgery was recorded for all patients.The clinical information and 1-year follow-up outcomes after intervention surgery of patients in the concurrent treatment group and the secondary treatment group,the outpatient management group and the home management group were compared.Result All 92 AMI patients were complicated with MVD,involving 2-4 coronary arteries with an average of(2.7±0.4)branches;51 patients underwent interventional treatment for all lesions during the same hospitalization period(concurrent treatment group),and 41 patients were re-hospitalized after intervention to treat non-AMI culprit blood vessels(secondary treatment group).All patients received intensive statin therapy and dual antiplatelet therapy after the first intervention.A total of 43 patients received cardiac rehabilitation intervention in the outpatient department after the first intervention(outpatient management group),and 49 patients performed rehabilitation exercises at home according to medical advice(home management group).The number of stents implanted during hospitalization in the concurrent treatment group was significantly higher than that in the secondary treatment group,and the difference was statistically significant(P<0.01).The 1-year follow-up results after intervention surgery showed that 14 out of 92 patients died,among which,the all-cause mortality and the incidence of heart failure in the concurrent treatment group were lower than those in the secondary treatment group,and the all-cause mortality and the incidence of heart failure in the outpatient management group were lower than those in the home management group(P﹤0.05).Conclusion Direct treatment of MVD doesn't increase mortality and heart failure in AMI patients,and outpatient cardiac rehabilitation can improve the 1-year prognosis of AMI patients after interventional surgery.