张慧平， 艾虎， 李辉，赵迎， 唐国栋， 郑耐心， 孙福成



非梗死相关血管慢性完全闭塞对行急诊介入治疗的ST段抬高型心肌梗死患者预后的影响

张慧平， 艾虎， 李辉，赵迎， 唐国栋， 郑耐心， 孙福成

摘要

关键词心肌梗死；血管成形术，经腔，经皮冠状动脉；冠状动脉闭塞；预后

作者单位：100730 北京市，北京医院 心内科

Prognostic Impact of Chronic Total Occlusion on Non-infarct-related Artery in Patients of Acute ST-elevation Myocardial Infarction With Emergent Primary Percutaneous Coronary Intervention

ZHANG Hui-ping, AI Hu, LI Hui, ZHAO Ying, TANG Guo-dong, ZHENG Nai-xin, SUN Fu-cheng.
Department of Cardiology, Beijing Hospital, Beijing (100730), China
Corresponding Author: SUN Fu-cheng, Email: fuchengsun@gmail.com

Abstract

Objective: To study the prognostic impact of chronic total occlusion (CTO) on non-infarct-related artery (non-IRA) in patients of acute ST-elevation myocardial infarction (STEMI) with emergent primary percutaneous coronary intervention (PCI).

Methods: In this prospective study, a total of 185 consecutive acute STEMI patients received early stage primary PCI in our hospital from 2010-01to 2011-06 were enrolled. The patients were divided into 2 groups: non-CTO group, n=160 and CTO group, n=25. The patients were followed-up for 1 year and the primary endpoint events included the hospitalization for angina, re-MI, heart failure or revascularization and cardiac death.

Results: ①There were more patients with diabetes and three vessel disease in CTO group than those in non-CTO group (40.0 % vs 20.0 %, P=0.049) and (68.0 % vs 36.3 %, P= 0.003); LVEF in CTO group was lower than non-CTO group (40.0 ± 20.1% vs 51.3 ± 15.3 %, P<0.05). ②The cardiac mortalities at 6-month and 1-year followed-up period were higher in CTO group than those in non-CTO group (26.3% vs 6.1%, P=0.013) and (31.6% vs 8.4%, P=0.010); 1-year primary endpoint eventswere higher in CTO group (52.6% vs 16.8%, P=0.001). ③Multivariate regression analysis revealed that non-IRA combining CTO (HR=3.889, 95% CI 1.239-4.206, P=0.020), cardiac shock (HR=3.229, 95% CI 2.760-3.725, P=0.012) and three vessel disease (HR=2.008, 95% CI 1.549-3.372, P=0.040) were the independent predictors for 1-year mortality in patients of acute STEMI with primary PCI.

Conclusion: Non-IRA combining CTO in STEMI patients with primary PCI are usually having poor prognosis.

Key words Acute myocardial infarction; Percutaneous coronary intervention; Chronic total occlusion; Infarct related artery; Prognosis

(Chinese Circulation Journal, 2016,31:20.)

在急性ST段抬高型心肌梗死（STEMI）患者的直接经皮冠状动脉介入治疗（PCI）中，遭遇非梗死相关血管的慢性完全闭塞（CTO）病变并不少见。CTO病变一般是指冠状动脉闭塞至少3个月以上的病变[1]。急性STEMI患者非梗死相关血管合并CTO所占的比例大约为12%～13%[2, 3]。研究发现，非梗死相关血管合并CTO的急性心肌梗死（AMI）患者达到完全血运重建的比例低于非梗死相关血管无CTO 的AMI患者[4, 5]。我们通过对行直接PCI治疗的急性STEMI患者特点的研究，并进行1年随访，分析非梗死相关血管合并CTO对行直接PCI的急性STEMI患者预后的影响。

1　资料与方法

对象：选择2010-01至2011-06连续在我院确诊急性STEMI并行直接PCI治疗的185例患者。急性STEMI的诊断依据2009年美国心脏病学会/美国心脏协会（ACC/AHA） STEMI管理指南[6]。所有急性STEMI患者从出现心肌梗死症状到行直接PCI治疗的时间均小于12小时。根据非梗死相关血管是否存在CTO病变将研究对象分为非梗死相关血管无CTO组（无CTO组）和非梗死相关血管合并CTO组（CTO组）。

方法：（1）一般资料：记录患者的性别、年龄、有无吸烟、有无高血压、糖尿病及心肌梗死病史，记录入院后首次静脉血低密度脂蛋白胆固醇（LDL-C）、肌酐（Scr）水平，并计算估测肾小球滤过率（eGFR）。……