ST段抬高型心肌梗死合并心肌桥对直接行经皮冠状动脉介入治疗的影响

目的观察ST段抬高型心肌梗死（STEMI）梗死相关动脉合并心肌桥对直接行经皮冠状动脉介入（PCI）治疗的影响。方法将594例STEMI直接行PCI治疗成功的患者分为两组：梗死相关动脉合并心肌桥者46例为肌桥组，梗死相关动脉未合并心肌桥者548例为对照组，比较两组直接行PCI治疗术后即刻冠状动脉造影结果和6个月主要心脏不良事件（死亡、靶血管重建、靶病变重建、非致死性心肌梗死）。结果594例患者术后即刻前向血流TIMI3级率为92．1％（547／594），其中肌桥组为60．9％（28／46），对照组为94．7％（519／548），两组比较差异有统计学意义（P〈0．01）。住院病死率为4．4％（26／594），其中肌桥组为13．0％（6／46），对照组为3．6％（20／548），两组比较差异有统计学意义（P〈0．01）。6个月主要心脏不良事件发生率肌桥组为22．5％（9／40），对照组为5．1％（27／528），两组比较差异有统计学意义（P〈0．01）。结论梗死相关动脉合并心肌桥患者直接PCI治疗术后即刻前向血流改善较差，可能是导致住院病死率高和6个月主要心脏不良事件常见的原因之一。

Effect of ST - elevation myocardial infarction related artery combined with myocardial bridge on primary percutaneous coronary artery intervention

Objective To study the effect of ST-elevation myocardial infarction(STEMI)related artery combined with myocardial bridge on primary percutaneous coronary artery intervention(PCI)therapy.Methods Five hundred and ninety-four patients underwent primary PCI therapy from March 1999 to April 2006 were retrospectively studied.These patients were divided into two groups at random:infarct related artery with myocardial bridge(myocardial bridge group),infarct related artery without myocardial bridge(control group).The difference of prompt coronary angiography finding and 6 months main adverse cardiovascular event(MACE)rate between the two groups were investigated.Results Thrombolysis in myocardial infarction(TIMI)outflow III rate was 92.1%(547/594)in patients promptly after PCI,it was 60.9%(28/46)in myocardial bridge group and 94.7%(519/548)in control group(P<0.01).Inpatient mortality rate was 4.4%(26/594)in 594 patients underwent primary PCI,13.0%(6/46)in myocardial bridge group and 3.6%(20/548)in control group(P<0.01).Six months MACE rate was 22.5%(9/40)in myocardial bridge group and 5.1%(27/528)in control group(P<0.01).Conclusion The artery grade outflow was poor in patients with infarct related artery with myocardial bridge,which may be related to high mortality rate and 6 months MACE rate in those patients.