| 李芹 张君毅 程康 赵志敬 陈静 杨宇红.急性ST 段抬高心肌梗死患者多支病变血运重建治疗策略的临床研究[J].,2016,16(20):3856-3859 |
| 急性ST 段抬高心肌梗死患者多支病变血运重建治疗策略的临床研究 |
| The Study of Acute ST Element Myocardial Infarction in Patients withMultivessel Disease Invasive Revascularization Strategy |
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| DOI： |
| 中文关键词: 急性心肌梗死 经皮冠状动脉介入 多支血管病变 血运重建 |
| 英文关键词: Acute myocardial infarction Percutaneous coronary intervention Multivessel disease Revascularization |
| 基金项目:国家863 重点课题(2012AA02A603)；西京医院助推计划（XJZT13Z08） |
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| 中文摘要: |
| 目的：分析急性ST 段抬高心肌梗死(acute ST segment elevation myocardial infarction ，STEMI)伴多支血管病变行急诊经皮冠
状动脉介入(percutaneous coronary intervention，PCI)治疗的策略，制定患者血运重建时机及最佳方案。方法：收集2008.10-2012.10
期间急性ST 段抬高心肌梗死伴多支血管病变行急诊PCI治疗患者资料，其中仅行罪犯血管PCI治疗组162 例，多支血管PCI治
疗组50 例、阶段PCI治疗组112 例，分析比较各组间短期（3 个月）死亡率和1 年、2 年、3 年死亡率及主要心血管事件（major
cardiovascular events，MACE)发生率。结果：①多支血管PCI组较罪犯血管PCI组有更高的短期死亡率（4.0%vs 2.5%，P＜0.05），
但其降低MACE 发生率（12.0%vs 15.4%，P＜0.05）；② 阶段PCI 组较罪犯血管PCI 组有更低的死亡率（短期和1 年、2 年、3年死
亡率均P＜0.05）及MACE 发生率（11.6%vs 15.4%，P＜0.05）；③ 多支血管PCI 组较阶段PCI 组有更高的短期死亡率（4.0%vs1.
8%，P＜0.05），长期随访无明显不同（6.0%vs 5.4%, P＞0.05）；MACE的发生率无明显差异（12.0%vs 11.6%，P＞0.05）。结论：当血
流动力学稳定时，合并多支血管病变的急性ST 段抬高心肌梗死仅对罪犯血管行PCI，随后行阶段PCI处理非梗死病变血管，这一
策略能显著改善患者的临床预后。 |
| 英文摘要: |
| Objective:To analyze the patient of acute ST-segment elevation myocardial infarction with multivessel disease who
underwent emergency percutaneous coronary intervention, explore the best treatment timing of revascularization and the best solution.Methods:A total of 324 acute ST-segment elevation myocardial infarction with multivessel disease underwent emergency PCI were
collected between October 2008 and October 2010, of which 162 underwent culprit-only PCI, 50 multivessel PCI during the index
procedure,112 had a staged PCI, short-term (within three months) mortality and mortality in 1-year, 2-year, 3-year and major
cardiovascular events （MACE) were analyzed.Results:Multivessel PCI was associated with an increased short-term mortality, but it
reduced the incidence of revascularization and reinfarction in long-termas compared to culprit-only PCI; staged PCI was associate with a
lower short- or long-term mortality or MACE as compared to a culprit-only PCI; multivessel PCI was associated with a higher short-term
mortality as compared to a staged PCI; there are no significant difference was found in terms of long-term mortality and the incidence of
target vessel revascularization or reinfarction.Conclusion:Our study support the current guidelines recommendation to perform
culprit-only PCI in ST-segment elevation myocardial infarction patients with multivessel disease without hemodynamic compromise,
followed by a staged PCI of non infarct-related significant lesions. |
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