急性ST段抬高型心肌梗死多支病变患者血运重建策略

急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）是一种发病率逐年上升的心血管急重症之一，致残、致死率高。40%~65%的STEMI患者存在冠状动脉多支病变（multi-vessel disease,MVD），与单支病变相比，并发MVD的STEMI患者心血管不良事件的发生率明显增加。目前，在不考虑外科干预的情况下，针对STEMI多支病变患者的治疗策略主要有3种:即仅对梗死相关血管（infarct-related artery,IRA）即罪犯血管（culprit vessel）行急诊经皮冠状动脉介入（Percutaneous Coronary Intervention,PCI）治疗（culprit-PCI）、同时对IRA及至少1支非梗死相关血管（non-infarct-related artery,non-IRA）行急诊PCI（MV-PCI）、对IRA行急诊PCI后择期对至少1支non-IRA行PCI（staged-PCI）。由于STEMI多支病变患者non-IRA病理生理状态相对特殊，因此，国内外对non-IRA的处理策略及处理时机存在争议。同时，随着临床新技术及新型口服药物不断发展，STEMI多支病变处理策略也不断完善。本文就STEMI多支病变患者血运重建策略研究进展进行综述。

Reperfusion strategies in patients with ST-segment elevation myocardial Infarction and multivessel disease

Acute ST-segment elevation myocardial Infarction (STEMI) is a severe cardiovascular disease with a rapidly increasing morbidity, and often causes adverse outcomes. About 40-65% of patients presenting with STEMI have multi-vessel disease (MVD). Compared with patients with single-vessel disease, the incidence of cardiovascular events in STEMI patients with MVD is much higher. Currently, there are three strategies for the treatment of STEMI patients with MVD when coronary artery bypass grafting is not preferred: percutaneous coronary intervention (PCI) confined to culprit vessel lesions only (culprit-PCI); PCI in which lesions in the culprit vessel as well as≥1 non-infarct-related artery (nonculprit vessel lesion) are treated in the same procedure (MV-PCI); and PCI confined to culprit vessel lesions only, after which ≥1 lesions in nonculprit vessel are treated during planned secondary procedures (staged-PCI). As the pathophysiological status of the STEMI patients with MVD is relatively unique, optimal strategy of the non-infarct-related artery in STEMI patients remains unclear. With the development of advanced techniques and new oral drugs, the treatment of STEMI patients has also been improved. This article reviews the advances of strategies for the treatment of STEMI patients with MVD.