摘要
目的：分析非梗死相关血管慢性完全闭塞（CTO）对接受直接经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI熄者预后的影响。方法：选择2010～01至2011-06连续在我院确诊急性STEMI并行早期直接PCI治疗的185例患者，分为非梗死相关血管无CTO组（无CTO组）和非梗死相关血管合并CTO组（CTO组），共150例患者完成了1年随访，主要终点为1年时因心绞痛、再次心肌梗死（MI）、心力衰竭而住院或再次血运重建以及心血管死亡。结果：（1）无CTO组160例（86．5％），CTO组25例（13．5％），CTO组患者糖尿病及冠状动脉三支血管病变的比例均显著高于无CTO组（40．0％vs20．0％，P=0．049；68．0％vs36．3％，P=0．003）；CTO组左心室射血分数显著低于无CTO组[（40．0±20．1）％vs（51．3±15．3）％，P〈0．05]，差异均有统计学意义。（2）CTO组患者6个月、1年的心血管死亡以及1年时的主要终点发生率均显著高于无CTO组（26．3％vs6．1％，P=0．013；31．6％vs8．4％，P=0．010；52．6％vs16．8％，P=0．001），差异均有统计学意义。（3）多因素分析显示，非梗死相关血管合并CTO[风险比（HR）=3．889，95％可信区间：1．239—4．206，P=0．0201、心原性休克（HR=3．229，95％可信区间：2．760～3．725，P=0．012）及冠状动脉三支血管病变（HR=2．008，95％可信区间：1．549～3．372，P=0．040）是行直接PCI的急性STEMI患者1年心血管死亡的独立预测因素。结论：非梗死相关血管存在CTO并接受直接PCI的急性STEMI患者多预后不良，非梗死相关血管合并CTO、心原性休克、冠状动脉三支血管病变是这类患者1年心血管死亡的独立预测因素。
Objective： To study the prognostic impact of chronic total occlusion （CTO） on non-infarct-related artery （non-IRA） in patients of acute ST-elevation myocardial infarction （STEMI） with emergent primary percutaneous coronary intervention （PCI）. Methods： In this prospective study, a total of 185 consecutive acute STEMI patients received early stage primary PCI in our hospital from 2010-01to 2011-06 were enrolled. The patients were divided into 2 groups： non-CTO group, n=160 and CTO group, n=25. The patients were followed-up for 1 year and the primary endpoint events included the hospitalization for angina, re-MI, heart failure or revascularization and cardiac death. Results： （1） There were more patients with diabetes and three vessel disease in CTO group than those in non-CTO group （40.0 % vs 20.0 %, P=0.049） and （68.0 % vs 36.3 %, P= 0.003）; LVEF in CTO group was lower than non-CTO group （40.0 ± 20.1% vs 51.3 ＋ 15.3 %, P〈0.05）. （2） The cardiac mortalities at 6-month and 1-year followed-up period were higher in CTO group than those in non-CTO group （26.3% vs 6.1%, P=0.013） and （31.6% vs 8.4%, P=0.010）; 1-year primary endpoint events were higher in CTO group （52.6% vs 16.8%, P=0.001）. （3） Multivariate regression analysis revealed that non-IRA combining CTO （HR=3.889, 95% CI： 1.239-4.206, P=0.020）, cardiac shock （HR=3.229, 95% CI 2.760-3.725, P=0.012） and three vessel disease （HR=2.008, 95% CI： 1.549-3.372, P=0.040） were the independent predictors for 1-year mortality in patients of acute STEMI with primary PCI. Conclusion： Non-IRA combining CTO in STEMI patients with primary PCI are usually having poor prognosis.
出处
《中国循环杂志》
CSCD
北大核心
2016年第1期20-24,共5页
Chinese Circulation Journal
关键词
心肌梗死
血管成形术
经腔
经皮冠状动脉
冠状动脉闭塞
预后
Acute myocardial infarction
Percutaneous coronary intervention
Chronic total occlusion
Infarct related artery
Prognosis
