不同血运重建策略对老年非ST段抬高型急性冠脉综合征合并多支血管病变患者预后的影响

摘要

目的 比较一次与分次经皮冠状动脉介入(PCI)治疗完全血运重建对高龄非ST段抬高型急性冠脉综合征(NSTE-ACS)合并多支血管病变(MVD)患者预后的影响.方法 回顾性分析陕西省第四人民医院心血管内科2016年6月至2017年1月住院治疗的高龄NSTE-ACS合并MVD患者110例,其中男性67例,女性43例,年龄(63.1±8.5)岁.根据完全血运重建策略不同分为一次PCI组(n=48)和分次PCI组(n=62),比较两组患者PCI治疗、住院期间主要并发症和院内主要不良心血管事件(MACEs)发生率.术后对患者随访6个月,比较两组心功能、心绞痛症状改善情况和MACEs发生率.采用SPSS 19.0统计软件对数据进行分析.组间比较采用t检验或χ2检验.结果 患者术前左室射血分数(LVEF)和院内全球急性冠状动脉事件注册(GRACE)评分差异无统计学意义(P>0.05).分次PCI组单次造影剂用量明显低于一次PCI组[(180.0±60.0)vs(230.0±70.0)ml,P=0.04],院内MACEs和住院期间主要并发症较一次PCI组显著降低[1.6%(1/62) vs 10.4%(5/48),P=0.04;4.8%(3/62)vs 18.8%(9/48),P=0.02].随访6个月结果表明分次PCI组较一次PCI组MACEs发生率降低[4.9%(3/61))vs 17.4%(8/46),P=0.03].结论 分次PCI完全血运重建安全有效,可能是高龄NSTE-ACS合并MVD患者优先选用的介入治疗策略.%Objective To compare the prognostic impact of different revascularization strategies, multi-staged versus single-staged percutaneous coronary intervention(PCI)in the elderly patients with non-ST elevation acute coronary syndrome(NSTE-ACS)compli-cated with multivessel disease(MVD).Methods A retrospective study was carried out on 110 elderly patients[67 males and 43 females, at an age of(63.1 ±8.5)years]suffering from NSTE-ACS complicated with MVD who were admitted in our department from June 2016 to January 2017.According to the revascularization, they were divided into single-staged PCI group(n=48)and multi-staged PCI group(n=62).The data of PCI and incidences of complications and major adverse cardiovascular events(MACEs)during hospitalization were observed and compared between the 2 groups.In the end of the 6 months' follow-up, heart function, relief of angina symptoms,and occurrence of MACEs were compared between the 2 groups.SPSS statistics 19.0 was used to analyze the data. Student's t test or Chi-square test was adopted for the comparison between the 2 groups.Results There were no significant differences in left ventricular ejection fraction(LVEF)and the in-hospital global registry of acute coronary events(GRACE)risk score before the operation between the 2 groups(P >0.05).The multi-staged PCI group had less usage of contract in coronary angiography [(180.0 ±60.0)vs(230.0 ±70.0)ml,P=0.04],and lower incidences of in-hospital MACEs[1.6%(1/62)vs 10.4%(5/48), P=0.04]and complications[4.8%(3/62)vs 18.8%(9/48), P=0.02]when compared with the single-staged PCI group.The occurrence of MACEs was also lower in the multi-staged group than the single-staged group in the end of follow-up[4.9%(3/61)vs 17.4%(8/46),P=0.03].Conclusion Multi-staged PCI is safe and effective for revascularization,and it might be an optimal strategy for the elderly NSTE-ACS patients complicated with MVD.