急性心肌梗死合并多支血管病变患者早期完全血运重建的临床疗效及预后分析

摘要

Objective To investigate the clinical efficacy and prognosis of different revascularization(complete or incomplete)for patients with acute myocardial infarction(AMI)complicated with multiple vessel disease(MVD)after emergency percutaneous coronary intervention(PCI).Methods The clinical data from 200 cases of AMI patients with MVD were retrospectively analyzed.According to the revascularization,we divided them into the complete revascularization group(82 cases,CR group)and the incomplete revascularization group(118 cases,IR group).After that,the CR group were divided into the early complete revascularization group(31 cases,CR1 group)and the elective complete revascularization group(51 cases,CR2 group).The baseline clinical characteristics,PCI treatment,drug use,clinical efficacy and long-term prognosis of the two groups were recorded.Results There was no significantly difference in the baseline clinical characteristics,general drug use,and coronary artery disease situation between the two groups(all P>0.05).CR group had a significantly higher number of stents than ICR group,and had less use of nitrates than IR group(all P<0.05).The recurrent angina,revascularization rate and major adverse cardiovascular events(MACE)of the IR group during hospitalization and post-hospital were significantly higher than those in the CR group within the 18-month follow-up.The recurrent angina pectoris and the incidence of MACE of the CR2 group was significantly higher than that in the CR1 group(all P<0.05).Cox proportional hazards regression analysis found that incomplete revascularization was an independent predictor for MACE(P<0.05).Conclusions The clinical curative effect and prognosis in patients with AMI and MVD receiving complete revascularization is superior to that of patients receiving incomplete revascularization by PCI,and the early complete revascularization is better than the selective complete revascularization.MACE is more likely to occur in patients treated with incomplete revascularization by PCI.%目的 探讨急性心肌梗死(AMI)合并多支血管病变(MVD)急诊PCI治疗患者后不同血运重建方式(不完全性或完全性)的临床疗效及预后的影响.方法 回顾我院200例AMI合并MVD患者的临床资料,按冠脉血运重建方式分为完全性血运重建组(CR组)82例和不完全性血运重建组(ICR组)118 例;CR组再分为早期直接完全血运重建组(CR1组)31例和择期分次完全血运重建组(CR2组)51例.分别记录两组患者的基线临床特征、PCI治疗情况、药物使用情况、PCI术后临床疗效及远期预后情况.结果 两组患者基线临床特征、一般药物使用情况、冠脉病变情况等均无统计学差异(P均>0.05).CR组置入支架数目明显多于ICR组,CR组硝酸酯类药物使用情况明显低于ICR组(P均<0.05);严格随访18个月,ICR组住院期间及院外再发心绞痛比例、再次血运重建比例和主要不良心血管事件(MACE)发生率均明显高于CR 组,CR2组再发心绞痛及MACE发生率明显高于CR1组(P均<0.05);Cox比例风险回归分析估算发现不完全血运重建是MACE的独立预测因子(P<0.05).结论 AMI合并MVD急诊PCI治疗患者完全性血运重建临床疗效及预后优于不完全性血运重建者,直接完全血运重建组临床疗效及预后优于择期分次完全血运重建.PCI治疗不完全血运重建患者术后易发MACE.