耿学峰,王悦涵,刘巍,成万钧,聂绍平,周玉杰,卢清玉

• 1:北京市海淀医院心内科
• 2:首都医科大学公共卫生学院
• 3:首都医科大学附属北京安贞医院北京市心肺血管研究所

摘要(Abstract)：

目的探讨急性心肌梗死合并多支冠状动脉病变患者行急诊经皮冠状动脉介入治疗(PCI)早期接受非靶血管PCI的安全性及远期临床疗效。方法分析2009年1月至2012年12月因急性ST段抬高心肌梗死于北京市海淀医院和首都医科大学附属北京安贞医院行急诊PCI治疗的多支冠状动脉病变患者704例,其中279例对靶血管行急诊PCI后在7 d内接受非靶血管PCI治疗(多血管PCI组),425例仅接受靶血管治疗(单血管PCI组)。记录两组患者的基本资料、临床特征,随访期间的主要不良心脏事件(MACE,包括死亡和再发心肌梗死)、靶血管再次血运重建(TVR)和术后12个月因胸痛再次入院情况。结果两组患者的Killip心功能分级和LVEF比较,差异均有统计学意义(均P<0.05)。平均随访35(1~54)个月,多血管PCI组的MACE事件发生率明显低于单血管PCI组[9例(3.4%)比31例(8.0%),P=0.018;其中包括,死亡5例(1.9%)比15例(3.9%),P=0.155;再发心肌梗死4例(1.5%)比16例(4.1%),P=0.060]。多血管PCI组发生MACE事件的危险性是单血管PCI组的0.393倍(RR 0.393,95%CI 0.181~0.854)。结论对合并多支冠状动脉病变的急性心肌梗死患者,在行急诊PCI早期对非梗死相关血管采取积极的PCI策略是安全可行的。

关键词(KeyWords)： 急性心肌梗死;多支血管病变;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(81470429)

作者(Author): 耿学峰,王悦涵,刘巍,成万钧,聂绍平,周玉杰,卢清玉

参考文献(References)：

• [1]Dalby M,Bouzamondo A,Lechat P,et al.Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction:a meta-analysis.Circulation,2003,108:1809-1814.
• [2]宋晓健,王敬萍,安健,等.急性心肌梗死385例治疗状况及影响因素分析.中国介入心脏病学杂志,2013,21:381-383.
• [3]Sorajja P,Gersh BJ,Cox DA,et al.Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction.Eur Heart J,2007,28:1709-1716.
• [4]Van de Werf F,Bax J,Betriu A,et al.Management of acute myocardial infarction in patients presenting with persistent STsegment elevation:the Task Force on the Management of STSegment Elevation Acute Myocardial Infarction of the European Society of Cardiology.Eur Heart J,2008,29:2909-2945.
• [5]Kushner FG,Hand M,Smith SC,et al.2009 focused updates:ACC/AHA guidelines for the management of patients with STelevation myocardial infarction(updating the 2004 guideline and2007 focused update)and ACC/AHA/SCAI guidelines on percutaneous coronary intervention(updating the 2005 guideline and 2007 focused update)a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol,2009,54:2205-2241.
• [6]Goldstein JA,Demetriou D,Grines CL,et al.Multiple complex coronary plaques in patients with acute myocardial infarction.N Engl J Med,2000,343:915-922.
• [7]Webb JG,Lowe AM,Sanborn TA,et al.Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial.J Am Coll Cardiol,2003,42:1380-1386.
• [8]Ma LX,Lu ZH,Wang L,et al.Culprit vessel only versus"oneweek"staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction.J Geriatr Cardiol,2015,12:226-231.
• [9]Alpert JS,Thygesen K,Antman E,et al.Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction..J Am Coll Cardiol,2000,36:959-969.
• [10]Levine GN,Bates ER,Blankenship JC,et al.2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention.A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.J Am Coll Cardiol,2011,58:e44-e122.
• [11]Kalarus Z,Lenarczyk R,Kowalczyk J,et al.Importance of complete revascularization in patients with acute myocardial infarction treated with percutaneous coronary intervention.Am Heart J,2007,153:304-312.
• [12]Wald DS,Morris JK,Wald NJ,et al.Randomized trial of preventive angioplasty in myocardial infarction.N Engl J Med,2013,369:1115-1123.
• [13]Kim MC,Jeong MH,Ahn Y,et al.What is optimal revascularization strategy in patients with multivesselcoronary artery disease in non-ST-elevation myocardial infarction?Multivessel or culprit-only revascularization.Int J Cardiol,2011,153:148-153.
• [14]Rigattieri S,Biondi-Zoccai G,Silvestri P,et al.Management of multivessel coronary disease after ST elevation myocardial infarction treated by primary angioplasty.J Interv Cardiol,2008,21:1-7.
• [15]Wald DS,Morris JK,Wald NJ,et al.Randomized trial of preventive angioplasty in myocardial infarction.N Engl J Med,2013,369:1115-1123.
• [16]Gershlick AH,Khan JN,Kelly DJ,et al.Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease:the Cv LPRIT trial.J Am Coll Cardiol,2015,65:963-972.