一次与分次经皮冠状动脉介入术完全血运重建对非ST段抬高型心肌梗死多支血管病变患者预后的影响
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摘要
目的探讨一次经皮冠状动脉介入治疗(PCI)完全血运重建对非ST段抬高型心肌梗死(NSTEMI)多支血管病变患者短期预后的影响。方法本研究为回顾性研究。选择2016年1月至2017年1月在陕西省第四人民医院住院治疗的NSTEMI多支血管病变患者为研究对象,根据介入性完全血运重建治疗策略的不同分为一次PCI组(60例)和分次PCI组(98例),比较两组围术期资料和主要并发症;术后随访12个月,比较两组心功能改善情况和主要不良心血管事件发生率。结果两组的年龄、性别、合并症、心功能和心肌酶等基线资料无明显差异(均为P>0.05)。此外,两组患者双支病变比例和人均支架置入数量均相似(均为P>0.05),但一次PCI组患者平均病变血管数量(2.2±0.6比2.8±0.5)、住院时间[(5.0±3.5)d比(11.2±6.4)d]和住院费用[(50 862.2±21 300.0)元比(66 522.1±27 445.0)元]较分次PCI组显著降低(均为P<0.05)。一次PCI组主要并发症较分次PCI组有增加趋势(13.3%比7.1%),但差异无统计学意义(P=0.21)。随访12个月,一次PCI组患者LVEF优于分次PCI组(59.6%±2.7%比54.2%±4.9%,P=0.03),且MACE发生率较分次PCI组显著降低[6(10.3%)比22(23.7%),P<0.0001]。结论本研究提示一次PCI完全血运重建可减少住院时间和住院费用,改善患者心功能和降低术后MACE发生率。
Objective To observe the prognostic impact of one-time and staged percutaneous coronary intervention(PCI) complete revascularization in patients with non-ST-elevation myocardial infarction(NSTEMI) and multivessel disease. Methods This study is a retrospective study. Patients with NSTEMI and multivessel disease were divided into one-time PCI group(n=60) and staged PCI group(n=98) according to the different treatment strategies. The perioperative data of PCI, the number of stent used per patient, hospitalization time, hospitalization expenses and complications were compared between the two groups. The incidence of major adverse cardiovascular events(MACE) and the change of LVEF were compared between the two groups at 12 months of follow-up after PCI. Results There were no significant differences in baseline data between age, gender, comorbidities, cardiac function, and myocardial enzymes(all P>0.05). In addition, the proportion of the two lesions and the number of stent placement were similar in both groups(all P>0.05), but in one-time PCI group the average number of lesions(2.2±0.6 vs. 2.8±0.5) and hospitalization time [(5.0±3.5) d vs.(11.2±6.4) d] and hospitalization costs [(50 862.2±21 300.0) yuan vs.(66 522.1±27 445.0) yuan] were significantly lower than that in staged PCI group(all P<0.05). The main complications in one-time PCI group were higher than those in staged PCI group(13.3% vs. 7.1%), but the difference was not statistically significant(P=0.21). The incidence of MACE in one-time PCI was significantly lower [6(10.3%) vs. 22(23.7%), P<0.0001] and the change of LVEF in one-time PCI group were significantly improved compared those in staged PCI group(59.6%±2.7% vs. 54.2%±4.9%, P=0.03). Conclusions One-time PCI complete revascularization can reduce hospitalization time and hospitalization expenses, and is also effective in improving LVEF and reduces the incidence of MACE in one year after PCI surgery, but more research is needed.
Objective To observe the prognostic impact of one-time and staged percutaneous coronary intervention(PCI) complete revascularization in patients with non-ST-elevation myocardial infarction(NSTEMI) and multivessel disease. Methods This study is a retrospective study. Patients with NSTEMI and multivessel disease were divided into one-time PCI group(n=60) and staged PCI group(n=98) according to the different treatment strategies. The perioperative data of PCI, the number of stent used per patient, hospitalization time, hospitalization expenses and complications were compared between the two groups. The incidence of major adverse cardiovascular events(MACE) and the change of LVEF were compared between the two groups at 12 months of follow-up after PCI. Results There were no significant differences in baseline data between age, gender, comorbidities, cardiac function, and myocardial enzymes(all P>0.05). In addition, the proportion of the two lesions and the number of stent placement were similar in both groups(all P>0.05), but in one-time PCI group the average number of lesions(2.2±0.6 vs. 2.8±0.5) and hospitalization time [(5.0±3.5) d vs.(11.2±6.4) d] and hospitalization costs [(50 862.2±21 300.0) yuan vs.(66 522.1±27 445.0) yuan] were significantly lower than that in staged PCI group(all P<0.05). The main complications in one-time PCI group were higher than those in staged PCI group(13.3% vs. 7.1%), but the difference was not statistically significant(P=0.21). The incidence of MACE in one-time PCI was significantly lower [6(10.3%) vs. 22(23.7%), P<0.0001] and the change of LVEF in one-time PCI group were significantly improved compared those in staged PCI group(59.6%±2.7% vs. 54.2%±4.9%, P=0.03). Conclusions One-time PCI complete revascularization can reduce hospitalization time and hospitalization expenses, and is also effective in improving LVEF and reduces the incidence of MACE in one year after PCI surgery, but more research is needed.
引文
[1] Navarese EP,De Servi S,Buffon A,et al.Clinical impact of simultaneous complete revascularization vs.culprit only primary angioplasty in patients with St-elevation myocardial infarction and multivessel disease:a meta-analysis [J].J Thromb Thrombolysis,2011,31(2):217-225.DOI:10.1007/s11239-010-0510-4.
[2] Widimsky P,Holmes DR Jr.How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease?[J].Eur Heart J,2011,32(4):396-403.DOI:10.1093/eurheartj/ehq410.
[3] Vlaar PJ,Mahmoud KD,Holmes DR Jr,et al.Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction:a pairwise and network meta-analysis [J].J Am Coll Cardiol,2011,58(7):692-703.DOI:10.1016/j.jacc.2011.03.046.
[4] Kornowski R,Mehran R,Dangas G,et al.Prognostic impact of staged versus "one-time" multivessel percutaneous intervention in acute myocardial infarction:analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial [J].J Am Coll Cardiol,2011,58(7):704-711.DOI:10.1016/j.jacc.2011.02.071.
[5] 中华医学会心血管病学分会;中华心血管病杂志编辑委员会.非ST段抬高急性冠脉综合征诊断和治疗指南(2016)[J].中华心血管病杂志,2017,45(5):359-367.DOI:10.3760/cma.j.issn.0253-3758.2017.05.003.Chinese Society of Cardiology,Editorial Committee of Chinese Journal of Cardiology.Guideline of diagnosis and therapy for non-ST elevation acute coronary syndrome [J].Chin J Cardiol,2017,45(5):359-367.DOI:10.3760/cma.j.issn.0253-3758.2017.05.003.
[6] 赵宽,黄新亮.急性心肌梗死合并多支血管病变患者完全血运重建的临床研究进展[J].中国心血管杂志,2018,23(4):351-352.DOI:10.3969/j.issn.1007-5410.2018.04.017.Zhao K,Huang XL.Research progress on complete revascularization in patients with acute myocardial infarction complicated with multi-vessel disease[J].Chin J Cardiovasc Med,2018,23(4):351-352.DOI:10.3969/j.issn.1007-5410.2018.04.017.
[7] Puymirat E,Taldir G,Aissaoui N,et al.Use of invasive strategy in non-ST-segment elevation myocardial infarction is a major determinant of improved long-term survival:FAST-MI(French Registry of Acute Coronary Syndrome)[J].JACC Cardiovasc Interv,2012;5(9):893-902.DOI:10.1016/j.jcin.2012.05.008.
[8] Wu C,Dyer AM,King SB ,et al.Impact of incomplete revascularization on long-term mortality after coronary stenting [J].Cir Cardiovasc Interv,2011,4(5):413-421.DOI:10.1161/CIRCINTERVENTIONS.111.963058.
[9] Hannan EL,Samadashvili Z,Walford G,et al.Staged Versus One-time Complete Revascularization With Percutaneous Coronary Intervention for Multi-Vessel Coronary Artery Disease Patients Without ST-Elevation Myocardial Infarction [J].Circ Cardiovasc Interv,2013,6(1):12-20.DOI:10.1161/CIRCINTERVENTIONS.112.974485.
[10] Sardella G,Lucisano L,Garbo R,et a1.Single-Staged Compared With Multi-Staged PCI in Multivessel NSTEMI Patients [J].J Am Coll Cardiol,2016,67(3):264-272.DOI:10.1016/j.jacc.2015.10.082.
[11] Layland J,Oldroyd KG,Curzen N,et al.Fractional flow reserve vs.angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction:the British Heart Foundation FAMOUS–NSTEMI randomized trial [J].Eur Heart J,2015,36(2):100-111.DOI:10.1093/eurheartj/ehu338.
[2] Widimsky P,Holmes DR Jr.How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease?[J].Eur Heart J,2011,32(4):396-403.DOI:10.1093/eurheartj/ehq410.
[3] Vlaar PJ,Mahmoud KD,Holmes DR Jr,et al.Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction:a pairwise and network meta-analysis [J].J Am Coll Cardiol,2011,58(7):692-703.DOI:10.1016/j.jacc.2011.03.046.
[4] Kornowski R,Mehran R,Dangas G,et al.Prognostic impact of staged versus "one-time" multivessel percutaneous intervention in acute myocardial infarction:analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial [J].J Am Coll Cardiol,2011,58(7):704-711.DOI:10.1016/j.jacc.2011.02.071.
[5] 中华医学会心血管病学分会;中华心血管病杂志编辑委员会.非ST段抬高急性冠脉综合征诊断和治疗指南(2016)[J].中华心血管病杂志,2017,45(5):359-367.DOI:10.3760/cma.j.issn.0253-3758.2017.05.003.Chinese Society of Cardiology,Editorial Committee of Chinese Journal of Cardiology.Guideline of diagnosis and therapy for non-ST elevation acute coronary syndrome [J].Chin J Cardiol,2017,45(5):359-367.DOI:10.3760/cma.j.issn.0253-3758.2017.05.003.
[6] 赵宽,黄新亮.急性心肌梗死合并多支血管病变患者完全血运重建的临床研究进展[J].中国心血管杂志,2018,23(4):351-352.DOI:10.3969/j.issn.1007-5410.2018.04.017.Zhao K,Huang XL.Research progress on complete revascularization in patients with acute myocardial infarction complicated with multi-vessel disease[J].Chin J Cardiovasc Med,2018,23(4):351-352.DOI:10.3969/j.issn.1007-5410.2018.04.017.
[7] Puymirat E,Taldir G,Aissaoui N,et al.Use of invasive strategy in non-ST-segment elevation myocardial infarction is a major determinant of improved long-term survival:FAST-MI(French Registry of Acute Coronary Syndrome)[J].JACC Cardiovasc Interv,2012;5(9):893-902.DOI:10.1016/j.jcin.2012.05.008.
[8] Wu C,Dyer AM,King SB ,et al.Impact of incomplete revascularization on long-term mortality after coronary stenting [J].Cir Cardiovasc Interv,2011,4(5):413-421.DOI:10.1161/CIRCINTERVENTIONS.111.963058.
[9] Hannan EL,Samadashvili Z,Walford G,et al.Staged Versus One-time Complete Revascularization With Percutaneous Coronary Intervention for Multi-Vessel Coronary Artery Disease Patients Without ST-Elevation Myocardial Infarction [J].Circ Cardiovasc Interv,2013,6(1):12-20.DOI:10.1161/CIRCINTERVENTIONS.112.974485.
[10] Sardella G,Lucisano L,Garbo R,et a1.Single-Staged Compared With Multi-Staged PCI in Multivessel NSTEMI Patients [J].J Am Coll Cardiol,2016,67(3):264-272.DOI:10.1016/j.jacc.2015.10.082.
[11] Layland J,Oldroyd KG,Curzen N,et al.Fractional flow reserve vs.angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction:the British Heart Foundation FAMOUS–NSTEMI randomized trial [J].Eur Heart J,2015,36(2):100-111.DOI:10.1093/eurheartj/ehu338.