Prognosis of different strategies of revascularization in patients with acute myocardial infarction caused by left main coronary lesions
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摘要: 目的 研究血运重建策略对左主干病变所致急性心肌梗死(AMI)患者预后的影响。方法 以2017年10月—2020年10月因左主干病变所致AMI的90例患者为研究对象，将其分为保守治疗组(19例)、经皮冠状动脉(冠脉)介入治疗(PCI)组(47例)和冠脉旁路移植(CABG)组(24例)。统计患者基本临床资料及冠脉病变特点。自发病后进行随访，统计全因死亡率及不良事件情况。结果 保守治疗组年龄高于PCI组和CABG组(P < 0.05)。PCI组患者血栓性病变比例和住院使用IABP的比例高于保守治疗组和CABG组(P < 0.05)。CABG组患者GRACE评分低于保守治疗组和PCI组(P < 0.05)。PCI组及CABG组不良事件发生率低于保守治疗组，生存率高于保守治疗组(P < 0.05)，PCI组与CABG组不良事件发生率及生存率比较差异无统计学意义。Cox回归分析可见PCI(HR=0.335，95%CI：0.163~0.689)及CABG(HR=0.297，95%CI：0.123~0.717)较保守治疗，均可降低患者的不良事件发生率。PCI(HR=0.405，95%CI：0.194~0.847)及CABG(HR=0.173，95%CI：0.056~0.535)可减少全因死亡率。结论 PCI及CABG与保守治疗比较，均可改善左主干病变所致AMI患者预后，提高生存率。Abstract: Objective To investigate the prognosis of different strategies of revascularization in patients with acute myocardial infarction(AMI)caused by left main coronary artery lesions.Methods A total of 90 patients with AMI due to left main coronary artery lesions from October 2017 to October 2020 were selected as the subjects. All the patients were divided into three groups, conservative treatment group(n=19), percutaneous coronary intervention (PCI) group(n=47), and coronary artery bypass graft group(CABG) group(n=24). The baseline clinical data and characteristics of coronary artery lesions of the patients were analyzed. All-cause mortality and adverse events after AMI were followed up and investigated.Results The age of the conservative treatment group was higher than that of the PCI group and CABG group(P < 0.05). The rates of thrombotic lesions and using IABP during hospitalization in the PCI group were higher than that in the conservative treatment group and CABG group(P < 0.05). GRACE scores in CABG group were lower than that in the conservative treatment group and PCI group(P < 0.05). The incidence of adverse events in PCI group and CABG group was lower than that in the conservative treatment group, but the survival rate was higher than the conservative treatment group(P < 0.05). There was no significant difference in the incidence of adverse events and survival rate between the PCI group and CABG group. Cox regression analysis showed that PCI (HR=0.335, 95%CI: 0.163-0.689) and CABG (HR=0.297, 95%CI: 0.123-0.717) both could reduce the incidence of adverse events compared with conservative treatment. Both PCI (HR=0.405, 95%CI: 0.194-0.847) and CABG (HR=0.173, 95%CI: 0.056-0.535) could reduce the all-cause mortality.Conclusion PCI and CABG both could improve the prognosis and survival rate compared with conservative treatment in patients with acute myocardial infarction caused by left main coronary artery lesions.
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表 1 基本临床资料及冠脉病变情况
Table 1. Baselinecharacteristics of clinical and coronary artery lesions
例(%), X±S 项目 保守治疗组(19例) PCI组(47例) CABG组(24例) 检验值 P值 年龄/岁 75.21±4.81 65.62±12.90 63.63±9.29 16.307 < 0.01 男性 11(57.9) 39(83.0) 20(83.3) 4.977 0.082 高血压史 14(73.7) 28(59.6) 16(66.7) 1.246 0.536 糖尿病史 7(36.8) 11(23.4) 9(37.5) 2.040 0.361 吸烟史 6(31.6) 26(55.3) 13(54.2) 3.278 0.194 PCI史 2(10.5) 5(10.6) 2(8.3) 0.223 1.000 脑血管病史 4(21.1) 7(14.9) 6(25.0) 1.302 0.562 外周血管病史 2(10.5) 2(4.3) 4(16.7) 3.229 0.225 房颤史 0(0) 5(10.6) 1(4.2) 2.494 0.343 发病-就诊时间/h 4.63±2.85 3.96±2.58 3.79±2.7 1.571 0.456 室性心律失常 3(15.8) 11(23.4) 2(8.33) 3.196 0.178 院前心肺复苏 0(0) 6(12.8) 0(0) 4.526 0.060 入院Killip分级>1级 6(31.6) 15(31.9) 3(12.5) 3.360 0.186 总胆固醇/(mmol·L-1) 4.61±1.23 4.06±1.18 4.70±1.39 2.894 0.235 甘油三酯/(mmol·L-1) 1.10±0.59 1.23±0.91 1.32±0.52 4.230 0.121 高密度脂蛋白胆固醇/(mmol·L-1) 1.13±0.27 0.99±0.28 0.99±0.23 3.118 0.210 低密度脂蛋白胆固醇/(mmol·L-1) 3.02±1.11 2.57±0.96 3.22±1.32 3.849 0.146 肌酐/(μmol·L-1) 86.89±39.96 105.43±60.24 82.06±22.73 2.697 0.260 GRACE评分/分 177.68±35.72 179.09±42.72 152.29±22.77 8.852 0.012 左室内径/mm 50.00±6.99 49.02±5.73 52.04±6.78 2.589 0.274 射血分数/% 46.33±12.26 46.33±13.57 50.57±11.32 1.665 0.435 室壁瘤 4(21.1) 6(12.8) 3(12.5) 0.975 0.722 前三岔病变 10(52.6) 30(63.8) 20(83.3) 4.854 0.088 合并右冠病变 8(42.1) 22(46.8) 15(62.5) 2.165 0.339 血栓性病变 3(15.8) 16(34.0) 1(4.2) 8.932 0.010 SYNTAX积分/分 35.08±6.55 27.60±5.94 37.05±5.98 5.376 0.068 院内使用IABP 4(21.1) 25(53.2) 4(16.7) 11.655 0.003 
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