多支血管病变对急性心肌梗死患者短期预后的影响

发布时间：2018-03-27 17:25

本文选题：急性心肌梗死　切入点：经皮冠状动脉介入治疗　出处：《浙江大学》2013年博士论文

【摘要】：背景与目标：经皮冠状动脉介入治疗(PCI)是目前急性心肌梗死(AMI)的主要治疗手段,且能够改善预后,目前建议应首先处理梗死相关血管(IRA)。虽然非梗死相关血管(NIRA)不作为此次的犯罪血管,但合并存在是否会增加患者的死亡率或不良事件的发生率?目前的研究大多数关注多支血管病变对AMI患者长期预后的影响,而本文旨在观察多支血管病变AMI患者的短期预后。样本与方法：我们序贯纳入了453名2009年1月-2011年11月因AMI于浙江大学医学院附属邵逸夫医院心内科成功行PCI术并随访3月的患者的临床资料及随访结果,并根据冠脉造影结果分为单支病变(n=141)与多支病变(n=312),并将多支病变进一步分为双支病变(n=145)与三支病变(n=167)分别进行分析讨论。结果：在随访到的453名成功行PCI术的AMI患者中,单支、双支、三支血管病变分别有31.1%、32.0%、36.9%；共随访了3月,单支、双支、三支病变组患者心源性死亡发生率分别为3.5%、3.4%、4.2%,组间无差异；非致命性心肌再梗死三组共发生2例(0.4%)；脑梗共发生6例(1.3%)；再次血运重建共发生9例(2.0%),主要不良心脑血管事件(MACCE)的发生率分别为4.3%、7.6%、9.6%,组间均无差异；无事件生存率三组间无显著性差异。结论：三支病变的患者年龄更大,左室射血分数更低,血肌酐更高,肌酐清除率更低,且更易合并高血压、糖尿病及脑梗塞病史；双支病变次之；多支病变的短期预后与单支病变无显著性差异。
[Abstract]:Background and objectives:. Percutaneous coronary intervention (PCI) is the main treatment for acute myocardial infarction (AMI) and can improve the prognosis. It is suggested that we should first deal with infarct-related vessels, although non-infarct-associated vessels (NIRAs) are not considered as criminal vessels. But does the combination increase the mortality rate or the incidence of adverse events? Most studies have focused on the effect of multivessel disease on the long-term prognosis of patients with AMI, while this study aims to observe the short-term prognosis of patients with multivessel disease AMI. Samples and methods:. We included clinical data and follow-up results of 453 patients who had successfully performed PCI from January 2009 to November 2011 in the cardiology department of run run Shaw Hospital affiliated to Zhejiang University School of Medicine and followed up for 3 months. According to the results of coronary angiography, the patients were divided into two groups: single vessel lesion and multivessel lesion, and the multivessel lesion was further divided into two vessel lesions, two vessel lesions, and three vessel lesions, respectively. Results:. Among the 453 AMI patients who were successfully performed PCI, 31.1% of them had 31. 1%, 32. 0% and 36. 9% of the three vessel lesions, followed up for 3 months. The incidence of cardiac death was 3. 5%, 3. 4% and 4. 2% in the single, double and three vessel groups, respectively, and there was no difference between the two groups. In the three groups of non-fatal myocardial reinfarction, there were 2 cases with myocardial infarction, 6 cases with cerebral infarction and 1.3 cases with cerebral infarction, 9 cases with re-revascularization and 2.0 cases with major adverse cardiovascular and cerebrovascular events. The incidence of major adverse cardiovascular and cerebrovascular events was 4.3%, 7.6% and 9.6%, respectively, and there was no difference between the two groups. There was no significant difference in the event free survival rate among the three groups. Conclusion:. The patients with three vessel disease were older, left ventricular ejection fraction was lower, serum creatinine was higher, creatinine clearance rate was lower, and was more likely to be associated with hypertension, diabetes mellitus and cerebral infarction. There was no significant difference in short-term prognosis between multi-vessel lesions and single-vessel lesions.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R542.22

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