一次和分次完全血运重建介入治疗对ST段抬高型急性心肌梗死合并多支血管病变患者临床预后的影响

Effect of primary and fractional complete revascularization interventional therapy on the clinical prognosis of patients with ST-segment elevation acute myocardial infarction complicated with multi-vessel disease

目的分析一次与分次经皮冠状动脉介入治疗(PCI)完全血运重在ST段抬高型急性心肌梗死(STEMI)合并多支血管病变(MVD)治疗中对患者临床预后的影响。方法回顾性分析2021年2月至2022年2月入德阳市人民医院接受诊疗的76例STEMI合并MVD患者,参考治疗方式分为研究组(n=38)与对照组(n=38);研究组行分次PCI完全血运重建,对照组行一次PCI完全血运重建。比较两组患者病变血管数量、左主干病变率、对比剂总量、支架总数、住院时间及主要心血管不良事件(MACE)(靶血管血运重建、心源性死亡、再发心肌梗死)发生率。结果研究组患者对比剂总量、支架总数分别为(374.84±123.39)mL、(3.61±1.34)枚,均明显高于对照组[(235.97±94.05)mL、(2.77±0.86)枚],住院时间为(11.53±4.29)d,明显长于对照组[(8.35±5.67)d],差异均有统计学意义(P<0.05);两组病变血管数量、左主干病变率比较,差异均无统计学意义(P>0.05)。研究组患者MACE发生率为2.63%,明显低于对照组(21.05%),差异有统计学意义(P<0.05)。结论STEMI合并MVD治疗中分次PCI完全血运重建较一次PCI完全血运重建可进一步降低患者MACE发生率。

Objective To analyze the effect of complete revascularization in single and staged percutaneous coronary intervention(PCI)on the clinical prognosis of patients with ST-segment elevation acute myocardial infarction(STEMI)complicated with multivessel disease(MVD).Methods A total of 76 patients with STEMI and MVD admitted to People's Hospital of Deyang from February 2021 to February 2022 were retrospectively analyzed.According to the treatment methods,they were divided into the study group(n=38)and the control group(n=38).The study group underwent staged PCI complete revascularization,and the control group underwent single PCI complete revascularization.The number of diseased vessels,the rate of left main coronary artery disease,the total amount of contrast agent,the total number of stents,the length of hospital stay and the incidence of major adverse cardiovascular events(MACE)(target vessel revascularization,cardiac death,recurrent myocardial infarction)were compared between the two groups.Results The total amount of contrast agent and total number of stents in the study group were(374.84±123.39)mL and(3.61±1.34)pieces,respectively,which were significantly higher than those in the control group[(235.97±94.05)mL and(2.77±0.86)pieces],the hospital stay was(11.53±4.29)d,which was significantly longer than that in the control group[(8.35±5.67)d],and the differences were statistically significant(P<0.05);there were no statistically significant differences in the number of diseased blood vessels and the incidence of left main trunk disease between the two groups(P>0.05).The incidence of MACE in the study group was 2.63%,which was significantly lower than that in the control group(21.05%),and the difference was statistically significant(P<0.05).Conclusion Staged PCI complete revascularization can further reduce the incidence of MACE in patients with STEMI and MVD.