周鹏,刘臣,谭宇,盛兆雪,李健楠,周金英,赵汉军,宋莉,颜红兵

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心

摘要(Abstract)：

目的通过冠状动脉造影影像特征发现急性ST段抬高型心肌梗死患者罪犯病变分支闭塞的预测因素。方法连续入选2014年1月至2015年12月阜外医院诊断急性ST段抬高型心肌梗死且行直接经皮冠状动脉介入治疗的患者共1223例,根据冠状动脉造影筛选出罪犯病变为分叉病变的患者共256例,收集患者的人口学资料、合并疾病及冠状动脉造影影像特征资料。结果 256例患者中,33例发生分支闭塞,223例未发生分支闭塞,多因素分析显示分支开口狭窄程度重(比值比为1.06,95%CI 1.03~1.09,P<0.001)和分支开口血栓(比值比为5.43,95%CI 1.23~23.93,P=0.025)是预测分支闭塞的独立危险因素。结论急性ST段抬高型心肌梗死患者罪犯病变分支闭塞与分支开口狭窄程度重和分支开口血栓有关。

关键词(KeyWords)： 急性ST段抬高型心肌梗死;分叉病变;分支闭塞;冠状动脉造影

Abstract:

Keywords:

基金项目(Foundation): 中国医学科学院医学与健康科技创新工程基金(2016-I2M-1-009)

作者(Author): 周鹏,刘臣,谭宇,盛兆雪,李健楠,周金英,赵汉军,宋莉,颜红兵

参考文献(References)：

• [1]Dudek D,Mehran R,Dziewierz A,et al.Impact of bifurcation target lesion on angiographic,electrocardiographic,and clinical outcomes of patients undergoing primary percutaneous coronary intervention(from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction[HORIZONS-AMI]trial).Euro Intervention,2013,9(7):817-823.
• [2]Kralev S,Poerner TC,Basorth D,et al.Side branch occlusion after coronary stent implantation in patients presenting with STelevation myocardial infarction:clinical impact and angiographic predictors.Am Heart J,2006,151(1):153-157.
• [3]Hildick-Smith D,de Belder A J,Cooter N,et al.Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions:the British Bifurcation Coronary Study:old,new,and evolving strategies.Circulation,2010,121(10):1235-1243.
• [4]Lassen JF,Holm NR,Banning A,et al.Percutaneous coronary intervention for coronary bifurcation disease:11th consensus document from the European Bifurcation Club.Euro Intervention,2016,12(1):38-46.
• [5]Melikian N,Airoldi F,Di Mario C.Coronary bifurcation stenting.Current techniques,outcome and possible future developments.Minerva Cardioangiol,2004,52(5):365-378.
• [6]Montecucco F,Carbone F,Schindler TH.Pathophysiology of ST-segment elevation myocardial infarction:novel mechanisms and treatments.Eur Heart J,2016,37(16):1268-1283.
• [7]Arbab-Zadeh A,Fuster V.The myth of the“vulnerable plaque“:transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment.J Am Coll Cardiol,2015,65(8):846-855.
• [8]Parodi G,Bellandi B,Valenti R,et al.Comparison of double(360mg)ticagrelor loading dose with standard(60 mg)prasugrel loading dose in ST-elevation myocardial infarction patients:the Rapid Activity of Platelet Inhibitor Drugs(RAPID)primary PCI 2 study.Am Heart J,2014,167(6):909-914.
• [9]Parodi G,Valenti R,Bellandi B,et al.Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients:RAPID(Rapid Activity of Platelet Inhibitor Drugs)primary PCI study.J Am Coll Cardiol,2013,61(15):1601-1606.
• [10]Koo BK,Waseda K,Kang HJ,et al.Anatomic and functional evaluation of bif urcation lesions undergoing percutaneous coronary intervention.Circ Cardiovasc Interv,2010,3(2):113-119.
• [11]Kloner RA.The importance of no-reflow/microvascular obstruction in the STEMI patient.Eur Heart J,2017,38(47):3511-3513.
• [12]Jolly SS,Cairns JA,Yusuf S,et al.Randomized trial of primary PCI with or without routine manual thrombectomy.N Engl J Med,2015,372(15):1389-1398.
• [13]Fr?bert O,Lagerqvist B,Olivecrona GK,et al.Thrombus aspiration during ST-segment elevation myocardial infarction.N Engl J Med,2013,369(17):1587-1597.
• [14]刘臣,周鹏,孙中伟,等.急性心肌梗死斑块破裂光学相干断层成像特征与外周血白细胞计数的关系.中国介入心脏病学杂志,2017,25(8):422-426.
• [15]Stone GW,Maehara A,Witzenbichler B,et al.Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction:the INFUSE-AMI randomized trial.JAMA,2012,307(17):1817-1826.
• [16]Dou K,Zhang D,Xu B,et al.An angiographic tool for risk prediction of side branch occlusion in coronary bifurcation intervention:the RESOLVE score system(Risk pr Ediction of Side branch Occ Lusion in coronary bifurcation inter VEntion).JACC Cardiovasc Interv,2015,8(1 Pt A):39-46.