多支血管病变急性非ST段抬高型心肌梗死不同手术方式对患者远期预后的比较

摘要

The effects of different treatments on long-term prognosis were compared of non-ST-segment elevation myocardial infarction with multivessel vessel disease. The different treatment methods include only dealing with culprit-only revascularization (COR) and one-time complete revascularization (CR). Methods A total of 140 patients treated in Hebei General Hospital from 2016-01 to 2018-05 were enrolled. According to the different treatment methods of NSTEMI combined with multivessel disease, the patients were excluded and the patients were divided into COR groups. (n=95) and CR group (n=35). Baseline data such as gender, age, smoking history, hypertension, diabetes, biochemical indicators, echocardiographic index, and interventional surgery related indicators were collected to compare the long-term prognosis of NSTEMI patients with multivessel disease. Results NSTEMI patients with multivessel disease were followed up for an average of 11.25 (5.38, 15.13) months. In the composite end point (all-cause death, recurrent myocardial infarction, revascularization, angina hospitalization), CR was compared with COR (8.57% vs. 6.32%, P=0.035), the difference was statistically significant. And there was a statistical difference between the two groups. In the secondary end point (angina recurrent, bleeding, arrhythmia, heart failure hospitalization, stroke), we compared one-time complete revascularization (CR) with culprit-only revascularization (48.58% vs. 23.15%, P=0.031). The difference between the two groups was still statistically significant. Conclusion For patients with NSTEMI complicated with multivessel disease, COR may be an ideal strategy and needs further confirmation in a multicenter, prospective, randomized controlled trial.%目的 比较非ST段抬高型心肌梗死(NSTEMI)合并多支血管病变,不同处理方式,仅处理罪犯血管(COR)和一次性完全血运重建(CR),两种不同的处理方式对患者远期预后的影响.方法 回顾性分析2016年1月至2018年5月于我院心血管内科行PCI治疗的NSTEMI患者140例,根据NSTEMI合并多支血管病变处理方式的不同,排除失访,将患者分为COR组(n=95)和CR组(n=35).收集入选者性别、年龄、吸烟史、高血压、糖尿病、生化指标、超声心动图指标、介入手术相关指标等基线资料,比较两种不同的处理方式对于NSTEMI合并多支血管病变患者远期预后的影响.结果 NSTEMI合并多支血管病变患者,平均随访11.25(5.38,15.13)个月,在复合终点(全因死亡,再发心肌梗死,再次血运重建,心绞痛住院)方面,CR与COR相比(8.57% vs. 6.32%,P=0.035),差异有统计学意义;在次要终点(心绞痛复发,出血,心律失常,心力衰竭住院,卒中)方面,CR与COR相比(48.58% vs. 23.15%, P=0.031),两组间差异仍有统计学意义.结论 对于NSTEMI 合并多支血管病变患者,COR可能为一个理想的策略,尚需多中心、前瞻性、随机对照试验进一步证实.