同时干预梗死相关动脉内闭塞病变以外临界病变对直接经皮冠状动脉介入治疗患者的影响

摘要

目的：探讨直接经皮冠状动脉介入（PCI）治疗中同时植入支架干预梗死相关动脉（IRA）内闭塞病变以外临界病变对急性心肌梗死（AMI）患者术中及预后的影响。方法选择因AMI行直接PCI治疗且IRA内存在闭塞病变以外临界病变的患者82例，闭塞病变行支架植入处理后根据是否对临界病变同时行支架植入干预分为观察组（42例）和对照组（40例），观察两组患者术中并发症及住院期间心血管事件发生率；术后1、6、12个月左心室舒张末期内径（LVEDd）及左心室射血分数（LVEF）。随访1年，观察两组患者的主要心血管不良事件（MACE）发生情况。结果观察组无复流现象发生率、术中并发症及住院期间心血管事件总发生率均高于对照组，差异均有统计学意义（均P＜0.05）；两组患者术后1、6、12个月LVEDd及LVEF比较，差异均无统计学意义（均P＞0.05）；两组患者术后1年内MACE发生率比较，差异无统计学意义（均P＞0.05）。结论直接PCI术中同时植入支架干预IRA内闭塞病变以外临界病变增加AMI患者无复流现象发生率、术中并发症及住院期间心血管事件的总发生率，而对患者1年内心功能及MACE无显著影响。%Objective To investigate the effect of simultaneous stent implantation on both occlusive and borderline lesions of infarct- related artery(IRA) in acute myocardial infarction(AMI) patients undergoing primary percutaneous coronary intervention (PCI). Methods Eighty two AMI patients with borderline lesion in IRA undergoing primary PCI were randomly divided into two groups:42 patients received simultaneous stent implantation on both occlusive and borderline lesion in IRA (study group) and 40 patients received stent implantation on occlusive lesion only (control group). The incidence of complications during operation and cardiovascular events in hospitalization period were observed, the left ventricular end diastolic dimension (LVEDd) and the left ventricular ejective fraction (LVEF) were measured in both groups at 1, 6 and 12 months after procedure. In addition, the major adverse cardiac events (MACE) within 1 year were observed in both groups. Results Incidence of no- reflow phenomenon, complication during operation and cardiovascular events in hospitalization period in study group was significantly higher than that in control group (al P<0.05). There was no statistical y significant difference between study group and control group in LVEDd and LVEF at 1, 6 and 12 months after the procedure(al P>0.05). There was no statistical y significant difference in MACE within 1 year of follow up between two groups (P>0.05). Conclusion Simultaneous stent implantation on both occlusive and borderline lesion in IRA is not beneficial for AMI patients undergoing PCI, on contrast, it may increase the incidence of complications.