作　　者： ; ; ; ; ; ; ; ; ;

机构地区： 汕头市中心医院

出　　处： 《实用医学杂志》 2018年第9期1508-1512,共5页

摘　　要： 目的针对多支冠脉病变的急性ST段抬高性心肌梗死(STEMI)患者,在成功进行梗死相关冠脉(IRA)急诊经皮冠状动脉介入术(PCI)后,探讨早期干预重度狭窄的非梗死相关冠脉(non-IRA),分析评估其临床可行性及安全性。方法共有165例患者入选,其中75例患者在急诊PCI术后同意早期干预重度狭窄的non-IRA,另外90例患者仅针对IRA进行干预。分析比较住院期间主要不良事件(全因死亡率、严重心律失常如室速、室颤),造影剂肾病、消化道出血、总住院时间等,以及随访期内全因死亡率、因心衰再次住院、因ACS再次住院、再次冠脉介入、反复心绞痛。结果 (1)住院期间:两组病例的全因死亡率、造影剂肾病发生率、呼吸机应用、严重心律失常(室速、室颤)、消化道出血、肺部感染、菌血症的发生率比较方面无统计学差异(P>0.05),但新发急性左心功能不全发生率方面比较,早期干预重度狭窄non-IRA组低于仅干预IRA组(P<0.05);(2)随访期间:两组病例的全因死亡率比较无统计学差异(P>0.05);而因心衰再次住院、因ACS再次住院、再次冠脉介入、以及反复心绞痛的比较方面,早期干预重度狭窄non-IRA组明显低于仅干预IRA组,差异具有统计学意义(P<0.005)。结论急性STEMI合并多支冠脉病变患者,在行急诊PCI之后早期对重度狭窄non-IRA采取PCI策略是安全可行的。 Objective To explore the clinical feasibility and safety of early intervention for severe stenosisof non-infarct related artery（non-IRA）in patients with acute ST-segment elevation myocardial infarction（STEMI）and multi-vessel disease（MVD）after successful primary percutaneous coronary intervention（PCI）for infarct-asso-ciated artery（IRA）. Methods From May 1 st,2011 to December 30 th,2016,165 patients with STEMI andMVD were enrolled in our study. After the completion of primary PCI in IRA,75 patients still in the hospitalagreed to undergo a second staged PCI in severe stenosis of non-infarct arteries. We analyzed the in-hospitaladverse events,the length of hospital stay and clinical outcomes during the follow-up in the study population.Results There was no significant difference in the incidence of adverse events between the two groups during hos-pitalization. However,compared to patients treated with the IRA-only PCI,those treated with early intervention forsevere stenosis of non-IRA was associated with greater benefits for clinical outcomes（including rehospitalization forheart failure,rehospitalization for ACS,recurrent angina pectoris,necessity for reintervention）during the follow-up except for the all-cause mortality. Conclusion Early intervention for severe stenosis of non-IRA is a feasibleand safe procedure in patients with acute STEMI and MVD after successful primary PCI.

关 键 词： 急性心肌梗死 冠状动脉多支病变 经皮冠状动脉介入治疗 早期干预

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