CAJ | 학술논문

目的：对急性心肌梗死（ AMI）合并冠状动脉多支血管病变（ MVD）患者，评估非梗死相关血管（ non-IRA）的干预策略。方法本研究为前瞻性随机对照研究，选择2009-01～2011-06成功行急诊冠状动脉介入治疗（ PCI）的302例符合入选标准AMI合并MVD患者，随机分为A组：近期（ AMI后7～10 d） PCI干预non-IRA病变和B组：根据缺血证据行non-IRA PCI治疗。强调两组患者均根据指南施行最优化药物治疗。主要终点事件为再发心肌梗死、靶血管重建（ TVR）和心因性死亡，次要终点事件为心因性再住院、心绞痛、心力衰竭、缺血相关的PCI治疗。结果共计288例患者完成24个月随访，A组145例，B组143例。其中A组和B组分别有12例和15例患者发生了主要终点事件（ P＝0．519），次要终点事件B组明显高于A组。在处理non-IRA过程中，两组均无围术期死亡发生。结论优化药物治疗基础上，AMI合并MVD患者近期干预non-IRA是安全的，能够明显降低心绞痛再发、心因性再住院和PCI的风险。但不能降低再梗死、靶血管重建、心因性死亡和心力衰竭的风险。
목적：대급성심기경사（ AMI）합병관상동맥다지혈관병변（ MVD）환자，평고비경사상관혈관（ non-IRA）적간예책략。방법본연구위전첨성수궤대조연구，선택2009-01～2011-06성공행급진관상동맥개입치료（ PCI）적302례부합입선표준AMI합병MVD환자，수궤분위A조：근기（ AMI후7～10 d） PCI간예non-IRA병변화B조：근거결혈증거행non-IRA PCI치료。강조량조환자균근거지남시행최우화약물치료。주요종점사건위재발심기경사、파혈관중건（ TVR）화심인성사망，차요종점사건위심인성재주원、심교통、심력쇠갈、결혈상관적PCI치료。결과공계288례환자완성24개월수방，A조145례，B조143례。기중A조화B조분별유12례화15례환자발생료주요종점사건（ P＝0．519），차요종점사건B조명현고우A조。재처리non-IRA과정중，량조균무위술기사망발생。결론우화약물치료기출상，AMI합병MVD환자근기간예non-IRA시안전적，능구명현강저심교통재발、심인성재주원화PCI적풍험。단불능강저재경사、파혈관중건、심인성사망화심력쇠갈적풍험。
Objective To evaluate short -term percutaneous coronary intervention (PCI) for non-infarction related artery ( IRA) compared with ischemia related PCI accompanied with optimized medical therapy in acute myocardial infarction ( AMI) and multivessel disease .Methods From January 2009 to June 2011 , a total of 302 patients with AMI and mutivessel disease were enrolled in this retrospective study .These patients underwent primary PCI and were randomly assigned to group A ( staged PCI for non-IRA within 7~10 days after AMI ) and group B ( no staged PCI group ) .In group B, subsequent PCI for non -IRA was recommended only for ischemia evidence .Optimized medical therapy was administrated for all of patients according to clinical guideline .The primary outcome was recurrence of myocardial infarction , target vessel revascularization ( TVR) and death from cardiac causes in 24 months follow -up.The secondary outcomes were PCI for ischemia , heart failure, angina and rehospitalization from cardiac causes .Results After 24 months follow-up visit, 288 patients finished the experiment in group A (145 patients) and group B (143 patients).The primary outcome occurred in 12 patients in group A and in 15 patients in group B (P=0.519).There was no patient dead in the PCI operation for non-IRA in two groups .But the secondary outcomes were obviously higher in group B than those in group A , inclusive revascularization , heart failure , refractory angina and rehospitalization . Conclusion In patients with AMI and multivessel coronary artery disease undergoing primary PCI , staged PCI within 7~10 days for non-IRA is safe and decrease the risk of revascularization , angina and rehospitalization .But staged PCI dose not reduce the risk of death from cardiac causes , myocardial infarction and heart failure .