CAJ | 학술논문

目的：评价开通梗死相关血管后择期完全血运重建经皮冠状动脉介入（PCI）策略和仅梗死相关血管PCI策略对急性ST段抬高型心肌梗死（ STEMI）合并多支病变患者预后的影响。方法纳入2012年4月-2013年12月北京安贞医院急诊科行急诊PCI的合并多支血管病变的STEMI患者59例。根据是否在同次住院期间择期行非梗死相关血管PCI分为2组：择期完全PCI组25例和仅梗死相关血管PCI组34例。观察比较2组患者基本临床资料、冠状动脉造影和PCI情况，记录3个月内相关不良事件（包括死亡、非致死性心肌梗死、顽固性心绞痛、再次血运重建）。结果择期完全PCI组和仅梗死相关血管PCI组冠状动脉造影（包括每支血管植入支架数、支架长度、支架直径等）和PCI情况（包括发病到血管开通时间、介入操作时间、围术期用药情况等）比较，差异均无统计学意义（ P ＞0．05），出院后用药情况（包括阿司匹林、氯吡格雷、β-受体阻滞剂等）差异亦无统计学意义（ P ＞0．05）。随访3个月，择期完全PCI组失访1例，仅梗死相关血管PCI组失访3例。仅梗死相关血管PCI组总不良事件比例高于择期完全PCI组（38．7％vs．12．5％，χ2＝4．685， P ＜0．05）。仅梗死相关血管PCI组出现顽固性心绞痛的比例高于择期完全PCI组（32．3％vs．8．3％，χ2＝4．539， P ＜0．05）。2组均未出现死亡病例。结论择期完全处理非梗死相关血管策略能够改善STEMI合并多支病变患者预后，预防顽固性心绞痛的发生。
목적：평개개통경사상관혈관후택기완전혈운중건경피관상동맥개입（PCI）책략화부경사상관혈관PCI책략대급성ST단태고형심기경사（ STEMI）합병다지병변환자예후적영향。방법납입2012년4월-2013년12월북경안정의원급진과행급진PCI적합병다지혈관병변적STEMI환자59례。근거시부재동차주원기간택기행비경사상관혈관PCI분위2조：택기완전PCI조25례화부경사상관혈관PCI조34례。관찰비교2조환자기본림상자료、관상동맥조영화PCI정황，기록3개월내상관불량사건（포괄사망、비치사성심기경사、완고성심교통、재차혈운중건）。결과택기완전PCI조화부경사상관혈관PCI조관상동맥조영（포괄매지혈관식입지가수、지가장도、지가직경등）화PCI정황（포괄발병도혈관개통시간、개입조작시간、위술기용약정황등）비교，차이균무통계학의의（ P ＞0．05），출원후용약정황（포괄아사필림、록필격뢰、β-수체조체제등）차이역무통계학의의（ P ＞0．05）。수방3개월，택기완전PCI조실방1례，부경사상관혈관PCI조실방3례。부경사상관혈관PCI조총불량사건비례고우택기완전PCI조（38．7％vs．12．5％，χ2＝4．685， P ＜0．05）。부경사상관혈관PCI조출현완고성심교통적비례고우택기완전PCI조（32．3％vs．8．3％，χ2＝4．539， P ＜0．05）。2조균미출현사망병례。결론택기완전처리비경사상관혈관책략능구개선STEMI합병다지병변환자예후，예방완고성심교통적발생。
Objective To investigate whether percutaneous coronary intervention ( PCI ) should be confined to the culprit vessel only or also nonculprit vessels during staged procedures in patients with ST -segment elevation myocardial infarc-tion (STEMI) and multivessel disease (MVD).Methods From April 2012 through December 2013, 59 patients with acute STEMI and multivessel disease who were undergoing primary PCI were enrolled .Patients were categorized into the culprit ves-sel only PCI strategy ( n =34) versus staged nonculprit vessels PCI ( n =25).The clinical characteristics of the patients at baseline and details regarding angiography and PCI were recorded and compared .The endpoints analyzed included the 3-month rates of total adverse cardiovascular events and its components , death, nonfatal myocardial infarction , target-vessel revascular-ization, and refractory angina.Results Details regarding angiography (number of stents per artery, stent length and stent di-ameter) and PCI ( symptoms to balloon time , PCI time and medication ) and medical therapy ( aspirin, statin and beta-bloc-ker, etc.) during perioperative period were similar in the two groups ( P >00.5 ).Follow-up information at 3 months were collected.One case in the staged nonculprit vessels PCI group and three cases in culprit vessel only PCI strategy group were lost follow up.Culprit vessel only PCI strategy versus staged nonculprit vessels PCI was associated with higher 3-month total adverse cardiovascular events (38.7%vs.12.5%,χ2 =4.685, P <0.05), and refractory angina (32.3% vs.8.3%,χ2 =4.539, P <0.05).There was no death in each group .Conclusion Staged nonculprit vessels PCI may improve the prognosis and prevent refractory angina in patients with ST-segment elevation myocardial infarction and multivessel disease .