ST 段抬高心肌梗死靶血管长病变急诊介入治疗的安全性及疗效分析

目的:探讨ST段抬高急性心肌梗死(ST-elevation myocardial infarction,STEMI)患者靶血管长病变(病变>25 mm)急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的临床疗效及安全性。方法:回顾性收集2009年1月-2010年6月因STEMI就诊于沈阳军区总医院并急诊行PCI处理的患者442例,以靶病变长度分为两组,即≤25 mm为短病变组(n=235)和>25mm为长病变组(n=207),均急诊行PCI治疗,分析和比较两组患者术前的基线资料、术中资料及并发症的发生情况、辅助措施(临时起搏、IABP、血栓抽吸装置)应用情况,术后30天、2年电话或临床随访,记录主要不良心血管事件(major adverse cardiac events,MACE)的发生情况。结果:与短病变组比较,长病变组吸烟者更多(81.6%vs 62.6%,P=0.000);以三支病变偏多(34.8%vs 24.7%,P=0.037);多枚支架使用率更高(1.47±0.63 vs 1.04±0.28,P=0.000),平均支架总长度显著增加(29.80±7.02 mm vs 22.95±5.58mm,P=0.000),手术成功率、术中并发症及辅助措施应用情况比较差异无统计学意义(P>0.05),30天及2年随访MACE的发生率比较差异无统计学意义(P>0.05)。结论:与急诊PCI治疗的STEMI短病变患者对比,长病变患者虽然病变复杂,多枚支架使用率高,平均支架总长度增加,但术中并发症、30天、2年内MACE与短病变患者相当,提示在以药物洗脱支架为主的介入治疗时代,急诊PCI处理STEMI靶血管长病变具有良好的疗效及安全性。

Safety and Efficacy of Emergency Percutaneous Coronary Intervention on ST-segment Elevation Myocardial Infarction Patients with Long Target Lesions*

Objective:To evaluate the clinical effects and safety of emergency percutaneous coronary intervention (PCI) on the acute ST-segment elevation myocardial infarction(STEMI) patients with long coronary lesions(>25 mm).Methods:A total of 442 patients with STEMI underwent emergency PCI from January 2009 to June 2010 were retrospectively collected and divided into two groups according to the target vessel length (> 25 mm, long lesion group, n=235 and 0.05). The 30-day and 2-year follow-up data showed no significant difference in the incidence of MACE between two groups.Conclusion:Compared with STEMI patients with short lesion who underwent emergent PCI treatment, the patienst with long lesion turned out to be more complicated in lesion characteristic appearance with more usage of multiple stents, but the incidence of complications and MACE in 30 days or 2 years after PCI were equal to the patients with short lesion. The PCI treatment of long lesion STEMI in the DES prevailing era was safe and efficient.