三种血运重建策略在STEMI合并多支病变患者PCI术后的应用研究被引量：2

Application of three revascularization strategies in patients with acute ST segment elevation myocardial infarction complicated with multivessel lesions after percutaneous coronary intervention

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摘要目的探讨仅处理罪犯病变(CO)、立即多支再血管化(I-MVR)、分期多支再血管化(S-MVR)三种血运重建策略在急性ST段抬高型心肌梗死(STEMI)合并多支病变患者经皮冠状动脉介入(PCI)术后的应用效果。方法回顾性分析2019年6月至2022年6月延安大学咸阳医院收治的100例STEMI合并多支病变患者的临床资料,按照治疗方式的不同将患者分为CO组34例、I-MVR组33例、S-MVR组33例,比较三组患者的手术情况,术前、术后3个月的左室射血分数(LVEF)及术后6个月不良心血管事件发生率。结果I-MVR组患者的支架植入数量、支架长度分别为(2.75±0.62)枚、(55.87±5.40)mm,S-MVR组分别为(2.83±0.55)枚、(56.29±4.93)mm,均明显多(长)于CO组的(2.13±0.35)枚、(30.54±3.81)mm,差异均有统计学意义(P<0.05),而I-MVR与S-MVR组患者的支架植入数量、支架长度比较差异均无统计学意义(P>0.05);S-MVR组患者造影剂用量、住院时间分别为(365.95±54.74)m L、(15.29±2.47)d,明显多(长)于I-MVR组的(251.92±35.90)m L、(10.71±2.60)d和CO组的(183.27±21.34)mL、(10.69±2.75)d,且I-MVR组患者的造影剂用量的明显多于CO组,差异均有统计学意义(P<0.05),但CO组和I-MVR组患者的住院时间比较差异无统计学意义(P>0.05);术后3个月,I-MVR组和S-MVR组患者的LVEF分别为(57.27±4.60)%,(58.43±4.79)%,明显高于CO组的(3.58±5.23)%,差异均有统计学意义(P<0.05),而I-MVR组和S-MVR组患者的LVEF比较差异无统计学意义(P>0.05);I-MVR组和S-MVR组患者的不良心血管事件总发生率分别为9.09%、6.06%,明显低于CO组的29.41%,差异均有统计学意义(P<0.05)。结论与CO比较,I-MVR、S-MVR有助于改善STEMI合并多支病变患者PCI术后心功能,降低不良心血管事件发生率,同时I-MVR能减少造影剂用量,缩短住院时间。 Objective To study the application effects of three revascularization strategies[culprit-lesion-only(CO),immediate multivessel revascularization(I-MVR),and staging multivessel revascularization(S-MVR)]in patients with acute ST segment elevation myocardial infarction(STEMI)complicated with multivessel lesions after percutaneous coronary intervention(PCI).Methods Retrospective analysis was made on the clinical data of 100 patients with STEMI complicated with multivessel disease admitted in Xianyang Hospital of Yan'an University from June 2019 to June 2022.According to the different treatment methods,they were divided into the CO group(34 patients),the I-MVR group(33 patients),and the S-MVR group(33 patients).The surgical conditions,left ventricular ejection fraction(LVEF)before and at 3 months after surgery,and the incidence of adverse cardiovascular events at 6 months after surgery were compared among the three groups.Results The number of tent implants and tent implants length were 2.75±0.62 and(55.87±5.40)mm in the I-MVR group,and 2.83±0.55 and(56.29±4.93)mm in the S-MVR group,which were significantly more(longer)than 2.13±0.35 and(30.54±3.81)mm in CO group(P<0.05).There was no statistically significant difference in the number of tent implants and tent implants length between the I-MVR and S-MVR groups(P>0.05).The amount of contrast agent and the length of hospital stay in S-MVR group were(365.95±54.74)mL and(15.29±2.47)d,which were significantly more(longer)than(251.92±35.90)mL and(10.71±2.60)d in the I-MVR group and(183.27±21.34)mL and(10.69±2.75)d in CO group(P<0.05);the amount of contrast agent in I-MVR group was significantly higher than that in the CO group(P<0.05);there was no statistically significant difference in length of hospital stay between CO group and I-MVR group(P>0.05).Three months after surgery,the LVEF in the I-MVR group and the S-MVR group were(57.27±4.60)%and(58.43±4.79)%,which were significantly higher than(3.58±5.23)%in the CO group(P<0.05);there was no statistically significant difference in LVEF between the I-MVR group and the S-MVR group(P>0.05).The incidences of adverse cardiovascular events in I-MVR group and S-MVR group were 9.09%and 6.06%,which were significantly lower than 29.41%in CO group(P<0.05).Conclusion Compared with CO,I-MVR and S-MVR can help improve the cardiac function and reduce the incidence of adverse cardiovascular events after PCI in STEMI patients with multivessel lesions,and I-MVR can reduce the amount of contrast agent and shorten the length of hospital stay.

作者何克强马艺语赵英亮 HE Ke-qiang;MA Yi-yu;ZHAO Ying-liang(WardⅥ,Department of Cardiovascular Medicine,Xianyang Hospital of Yan'an University,Xianyang 712000,Shaanxi,CHINA)

机构地区延安大学咸阳医院心血管内科五病区

出处《海南医学》 CAS 2023年第22期3240-3244,共5页 Hainan Medical Journal

基金国家自然科学基金(编号:81660079) 陕西省自然科学基础研究计划项目(编号:2016JM8123)。

关键词急性ST段抬高型心肌梗死经皮冠状动脉介入术血运重建左室射血分数不良心血管事件 Acute ST segment elevation myocardial infarction Percutaneous coronary intervention Revascularization Left ventricular ejection fraction Adverse cardiovascular events

分类号 R542.22 [医药卫生—心血管疾病]

作者简介第一作者:何克强(1986-),男,主治医师,主要研究方向为心血管内科临床及介入诊疗工作;通讯作者:马艺语(1991-),女,主治医师,主要研究方向为心血管内科临床及介入诊疗工作,E-mail:Maman2023@163.com。