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目的:分析急性ST段抬高心肌梗死(acute ST segmentelevation myocardial infarction,STEMI)伴多支血管病变行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的策略,制定患者血运重建时机及最佳方案。方法:收集2008.10-2012.10期间急性ST段抬高心肌梗死伴多支血管病变行急诊PCI治疗患者资料,其中仅行罪犯血管PCI治疗组162例,多支血管PCI治疗组50例、阶段PCI治疗组112例,分析比较各组间短期(3个月)死亡率和1年、2年、3年死亡率及主要心血管事件(major cardiovascularevents,MACE)发生率。结果:①多支血管PCI组较罪犯血管PCI组有更高的短期死亡率(4.0%vs 2.5%,P<0.05),但其降低MACE发生率(12.0%vs 15.4%,P<0.05);②阶段PCI组较罪犯血管PCI组有更低的死亡率(短期和1年、2年、3年死亡率均P<0.05)及MACE发生率(11.6%vs 15.4%,P<0.05);③多支血管PCI组较阶段PCI组有更高的短期死亡率(4.0%vsl.8%,P<0.05),长期随访无明显不同(6.0%vs 5.4%,P>0.05);MACE的发生率无明显差异(12.0%vs 11.6%,P>0.05)。结论:当血流动力学稳定时,合并多支血管病变的急性ST段抬高心肌梗死仅对罪犯血管行PCI,随后行阶段PCI处理非梗死病变血管,这一策略能显著改善患者的临床预后。
Objective: To analyze the strategy of emergency percutaneous coronary intervention (PCI) in acute ST-segment elevation myocardial infarction (STEMI) with multivessel disease and to establish the timing and extent of revascularization in patients with acute ST-segment elevation myocardial infarction Good plan Methods: Data of patients undergoing PCI during acute ST-segment elevation myocardial infarction with multivessel disease were collected during the period of October 2008 to October 2010. Among them, only 162 cases of criminal PCI, 50 cases of multi-vessel PCI, and PCI One hundred and twelve cases were analyzed. The short-term (3-month) mortality and 1-year, 2-year and 3-year mortality and the incidence of major cardiovascularevents (MACE) were compared between the groups. Results: The multi - vessel PCI group had a higher short - term mortality rate (4.0% vs 2.5%, P <0.05) than the criminal arteries PCI group, but decreased the incidence of MACE (12.0% vs 15.4%, P <0.05). ② The PCI group had lower mortality rate (P <0.05) and MACE incidence rate (11.6% vs 15.4%, P <0.05) than the criminal arteries PCI group at the first, second, third, and third years; The multi-vessel PCI group had higher short-term mortality (4.0% vs 1.8%, P <0.05) and no significant difference in long-term follow-up (6.0% vs 5.4%, P> 0.05) No significant difference (12.0% vs 11.6%, P> 0.05). Conclusions: When hemodynamics are stable, acute ST-segment elevation myocardial infarction with multivessel disease is performed only on the culprit vessel, followed by stage PCI for non-infarcted vessels, which can significantly improve the patient’s clinical outcome .