不同血管的急性下壁心肌梗死老年患者直接PCI术后短期预后分析(1)
[摘要] 目的 探讨急性下壁ST段抬高型心肌梗死(STEMI)行直接经皮冠状动脉介入治疗(pPCI)的老年患者，不同罪犯血管(IRA)对短期临床预后的影响。 方法 选择2015年1月～2016年4月徐州医科大学附属医院心内科行pPCI的下壁STEMI并成功开通靶血管的老年患者(≥60岁)133例。根据IRA不同将患者分为右冠状动脉组(RCA组，103例)和左回旋支组(LCX组，30例)。收集所有入选患者一般临床资料并随访患者术后30 d内主要不良心血管事件(MACE)，包括心源性死亡、心力衰竭/心源性休克、恶性心律失常及靶血管血运重建。 结果 RCA组术后7 d及随访30 d后所测得LVEF明显低于LCX组[(47.1±8.4)%比(53.4±7.1)%，(49.5±8.9)%比(56.3±6.9%)]，差异有统计学意义(P < 0.05)。RCA组随访期内共出现45例MACE事件，而LCX组MACE事件仅6例，RCA组MACE事件发生率明显高于LCX组(43.7%比20.0%)，差异有统计学意义(P < 0.05)。 结论 IRA为RCA的下壁STEMI老年患者短期临床预后较LCX者差。
[关键词] 老年患者；下壁心肌梗死；直接经皮冠状动脉介入治疗；罪犯血管；短期预后
[中图分类号] R542.22 [文献标识码] A [文章编号] 1673-7210(2017)05(b)-0056-04
[Abstract] Objective To investigate the elderly patients' short-term clinical prognosis of acute inferior wall ST-segment elevation myocardial infarction (STEMI) with different infarct-related artery (IRA) undergoing primary percutaneous coronary intervention (pPCI). Methods From January 2015 to April 2016， in Department of Cardiology of Affiliated Hospital of Xuzhou Medical University， 133 elderly patients (≥60 years) with the inferior wall STEMI undergoing pPCI successfully were selected. According to difference of IRA， the enrolled elderly patients were divided into rightcoronary artery group (RCA group， n = 103) and left circumflex group (LCX group， n = 30). The patients' general clinical characteristic， and all patients followed up within 30 d of major adverse cardiovascular events (MACE)， including cardiacdeath， heart failure or cardiogenic shock， malignant arrhythmia and target vessel revascularization were collected. Results LVEF of RCA group after operation 7 d and follow-up 30 d were significantly lower than those of LCX group [(47.1±8.4)% vs (53.4±7.1)%， (49.5±8.9)% vs (56.3±6.9)%，]， the differences were statistically significant (P < 0.05). During the follow-up period， there were 45 MACE case in the group RCA， only 6 MACE cases in the group LCX. incidence of MACE in two groups was compared (43.7% vs 20.0%)， the difference was statistically significant (P < 0.05). Conclusion RCA induced inferior STEMI in elderly patients has a poorer short-term prognosis than LCX.
[Key words] Elderly patients； Inferior myocardial infarction； Primary percutaneous coronary intervention； Infarct-related artery； Short-termprognosis
隨着社会的发展、生活水平的提高，冠心病发病率急剧上升，同时急性下壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)作为冠心病最危急的一种急症，其发病率也随之越来越高。直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention，pPCI)作为快速、安全、高效开通罪犯血管(infarct-related artery，IRA)的一种治疗手段，已被国内外各大指南所推荐[1-4]。既往有文献报道[5]，前壁STEMI具有较低的左心室射血分数，且慢性心力衰竭的发生率及累积的心源性死亡率要明显高于下壁STEMI，前壁STEMI患者临床预后较下壁STEMI者差。但下壁STEMI不同IRA的预后如何报道较少，而年龄≥60岁的老年患者下壁STEMI不同IRA的预后情况尚未见报道。本研究旨在通过对老年患者不同IRA的下壁STEMI临床资料进行分析，探讨IRA不同所致的临床预后的差异。, http://www.100md.com(李承刚 夏勇 高雯 童江涛)
[关键词] 老年患者；下壁心肌梗死；直接经皮冠状动脉介入治疗；罪犯血管；短期预后
[中图分类号] R542.22 [文献标识码] A [文章编号] 1673-7210(2017)05(b)-0056-04
[Abstract] Objective To investigate the elderly patients' short-term clinical prognosis of acute inferior wall ST-segment elevation myocardial infarction (STEMI) with different infarct-related artery (IRA) undergoing primary percutaneous coronary intervention (pPCI). Methods From January 2015 to April 2016， in Department of Cardiology of Affiliated Hospital of Xuzhou Medical University， 133 elderly patients (≥60 years) with the inferior wall STEMI undergoing pPCI successfully were selected. According to difference of IRA， the enrolled elderly patients were divided into rightcoronary artery group (RCA group， n = 103) and left circumflex group (LCX group， n = 30). The patients' general clinical characteristic， and all patients followed up within 30 d of major adverse cardiovascular events (MACE)， including cardiacdeath， heart failure or cardiogenic shock， malignant arrhythmia and target vessel revascularization were collected. Results LVEF of RCA group after operation 7 d and follow-up 30 d were significantly lower than those of LCX group [(47.1±8.4)% vs (53.4±7.1)%， (49.5±8.9)% vs (56.3±6.9)%，]， the differences were statistically significant (P < 0.05). During the follow-up period， there were 45 MACE case in the group RCA， only 6 MACE cases in the group LCX. incidence of MACE in two groups was compared (43.7% vs 20.0%)， the difference was statistically significant (P < 0.05). Conclusion RCA induced inferior STEMI in elderly patients has a poorer short-term prognosis than LCX.
[Key words] Elderly patients； Inferior myocardial infarction； Primary percutaneous coronary intervention； Infarct-related artery； Short-termprognosis
隨着社会的发展、生活水平的提高，冠心病发病率急剧上升，同时急性下壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)作为冠心病最危急的一种急症，其发病率也随之越来越高。直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention，pPCI)作为快速、安全、高效开通罪犯血管(infarct-related artery，IRA)的一种治疗手段，已被国内外各大指南所推荐[1-4]。既往有文献报道[5]，前壁STEMI具有较低的左心室射血分数，且慢性心力衰竭的发生率及累积的心源性死亡率要明显高于下壁STEMI，前壁STEMI患者临床预后较下壁STEMI者差。但下壁STEMI不同IRA的预后如何报道较少，而年龄≥60岁的老年患者下壁STEMI不同IRA的预后情况尚未见报道。本研究旨在通过对老年患者不同IRA的下壁STEMI临床资料进行分析，探讨IRA不同所致的临床预后的差异。, http://www.100md.com(李承刚 夏勇 高雯 童江涛)