不同血管的急性下壁心肌梗死老年患者直接PCI术后短期预后分析

摘要

目的 探讨急性下壁ST段抬高型心肌梗死(STEMI)行直接经皮冠状动脉介入治疗(pPCI)的老年患者,不同罪犯血管(IRA)对短期临床预后的影响.方法 选择2015年1月～2016年4月徐州医科大学附属医院心内科行pPCI的下壁STEMI并成功开通靶血管的老年患者(≥60岁)133例.根据IRA不同将患者分为右冠状动脉组(RCA组,103例)和左回旋支组(LCX组,30例).收集所有入选患者一般临床资料并随访患者术后30 d内主要不良心血管事件(MACE),包括心源性死亡、心力衰竭/心源性休克、恶性心律失常及靶血管血运重建.结果 RCA组术后7d及随访30 d后所测得LVEF明显低于LCX组[(47.1±8.4)％比(53.4±7.1)％,(49.5±8.9)％比(56.3±6.9％)],差异有统计学意义(P＜0.05).RCA组随访期内共出现45例MACE事件,而LCX组MACE事件仅6例,RCA组MACE事件发生率明显高于LCX组(43.7％比20.0％),差异有统计学意义(P＜0.05).结论 IRA为RCA的下壁STEMI老年患者短期临床预后较LCX者差.%Objective To investigate the elderly patients' short-term clinical prognosis of acute inferior wall ST-segment elevation myocardial infarction (STEMI) with different infarct-related artery (IRA) undergoing primary percutaneous coronary intervention (pPCI).Methods From January 2015 to April 2016,in Department of Cardiology of Affiliated Hospital of Xuzhou Medical University,133 elderly patients (≥60 years) with the inferior wall STEMI undergoing pPCI successfully were selected.According to difference of IRA,the enrolled elderly patients were divided into rightcoronary artery group (RCA group,n =103) and left circumflex group (LCX group,n =30).The patients' general clinical characteristic,and all patients followed up within 30 d of major adverse cardiovascular events (MACE),including cardiacdeath,heart failure or cardiogenic shock,malignant arrhythmia and target vessel revascularization were collected.Results LVEF of RCA group after operation 7 d and follow-up 30 d were significantly lower than those of LCX group [(47.1±8.4)％ vs (53.4±7.1)％,(49.5±8.9)％ vs (56.3±6.9)％,],the differences were statistically significant (P ＜ 0.05).During the follow-up period,there were 45 MACE case in the group RCA,only 6 MACE cases in the group LCX.incidence of MACE in two groups was compared (43.7％ vs 20.0％),the difference was statistically significant (P ＜ 0.05).Conclusion RCA induced inferior STEMI in elderly patients has a poorer short-term prognosis than LCX.