心肌梗死伴多支血管病变患者非梗死相关动脉处理时机的探讨

目的总结和分析因急性心肌梗死（acute myocardial infarction，AMI）伴多支血管病变行急诊经皮冠状动脉介入（percutaneous coronary intervention，PCI）治疗患者非梗死相关动脉处理情况，探讨非梗死相关动脉的处理时机。方法选择成功行急诊PCI治疗的合并多支血管病变AMI患者252例，其中未处理非梗死相关动脉用药物治疗51例，行冠状动脉动脉旁路移植术5例；而需处理非梗死相关动脉患者196例，其中7d内处理非梗死相关动脉（排除急诊PCI治疗当时同时处理非梗死相关动脉的患者）19例，7—14d内处理的患者81例，28-35d处理的患者96例。回顾性分析各组的一般临床资料，冠状动脉病变情况，观察的重点为各组3个月及6个月内主要心血管事件及再住院率。结果与其他组相比，28—35d干预组6个月内主要不良心血管事件（9．38％）、因心源性疾病二次入院率最低（10．4％）（P〈0．05）。结论在心肌梗死后第28—35天干预AMI患者非梗死相关动脉可能更有利于改善患者的预后。

Treatment timing for non-infarct-related artery in patients with multi-vessel disease and acute myocardial infarction

Objectives To summarize and analyze the clinical characteristics of patients with multi-vessel disease and acute myocardial infarction（AMI） receiving emergency percutaneous coronary intervention （PCI） and to explore the treatment timing for non-infarct-related artery （NIRA）. Methods Totally 252 patients with multi-vessel disease and AMI who underwent emergency PCI successfully were included in this study. Among them,NIRA in 51 patients were treated by medicine without PCI, NIRA in 5 patients were treated by coronary artery bypass graft surgery. NIRA in 196 patients were treated by PCI, of which, 19 patients were treated in 7 days （excluding at the time of emergency PCI）, 81 patients were treated in 7-14 days and 96 patients were treated in 28-35 days. Clinical characteristics, coronary lesions, complications and especially the risks of readmissions and major adverse coronary events （MACE） in 3 months and 6 months were analyzed. Results The risks of MACE in 6 months and readmissions due to cardiac disease were much lower in patients who underwent PCI for NIRA in 28-35 days after AMI （MACE： 9.38%, readmission rate： 10.4%, P〈 0.05 ）. Conclusions It is more conducive to improve the outcomes of patients with AMI when treating NIRA in 28- 35 days after myocardial infarction.