合并非梗死相关血管慢性完全闭塞病变对急性ST段抬高型心肌梗死患者预后的影响

目的：研究合并非梗死相关血管慢性完全闭塞(CTO)病变对急性ST段抬高型心肌梗死(STEMI)患者预后的影响。方法选取2014年3月至2015年3月中国人民解放军第92医院心内科收治的170例经皮冠状动脉介入治疗(PCI)的急性STEMI患者为研究对象，其中合并非梗死相关血管慢性完全闭塞者20例(CTO组)，非梗死相关血管无慢性完全闭塞者150例(无CTO组)。比较两组患者的临床特征、介入治疗情况及随访结果，并分析影响患者预后的危险因素。结果与无CTO组比较，CTO组糖尿病、既往心肌梗死、多支血管病变及心源性休克患者所占比例较多，分别为40.0%、15.0%、100.0%及35.0%；无CTO组患者院内死亡率为6.3%，明显低于CTO组的21.4%，且两者比较差异有统计学意义(P<0.05)；CTO组患者在6个月及一年时的心血管病变死亡发生率为28.5%、35.7%，明显高于无CTO组的5.5%、8.7%，且差异均有统计学意义(P<0.05)。通过COX回归分析发现糖尿病、左室射血分数<40%、心源性休克、梗死相关血管为左前降支以及年龄>75岁是影响患者预后的独立危险因素。结论非梗死相关血管慢性完全闭塞病变可增加急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗的死亡率，而且患者预后多不良。

Effect of chronic total occlusion in a non-infarct-related artery on the prognosis of patients with acute ST-segment elevation myocardial infarction

Objective To study the effect of chronic total occlusion (CTO) in a non-infarct-related artery on the prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI). Methods One hundred and seventy patients with acute STEMI treated by percutaneous coronary intervention (PCI) in the Department of Cardiolo-gy, No.92 Hospital of Chinese PLA from March 2014 to March 2015 were selected, including 20 patients with chronic to-tal occlusion in a non-infarct-related artery (CTO group) and 150 patients without chronic total occlusion in a non-in-farct-related artery (non-CTO group). The clinical data, interventional therapy status, follow-up results of the two groups were compared, and the risk factors of short-term and long-term prognosis were analyzed. Results In CTO group, pa-tients with diabetes, previous myocardial infarction, multivessel disease and cardiogenic shock accounted for 40.0%, 15.0%, 100.0%and 35.0%, which were significantly higher than those of non-CTO group. The hospital mortality rate was 6.3%in non-CTO group, which was significantly lower than that of CTO group of 21.4%(P<0.05). The 6-month and one-year cardiovascular disease death rates were 28.5%, 35.7%, significantly higher than those of non-CTO group of 5.5%, 8.7%(P<0.05). Cox regression analysis showed that diabetes, left ventricular ejection fraction less than 40%, car-diogenic shock, infarct-related left anterior descending, and age more than 75 years were the independent prognostic fac-tors. Conclusion Chronic total occlusion of non-infarct-related artery can increase the mortality rate of percutaneous coronary intervention in patients with acute STEMI, and the prognosis is often poor.