| 周峻冉 池一凡 侯文明 牛兆倬 生伟 林明山 孙龙△.不同干预方式及干预时机对急性非ST 段抬高型心肌梗死伴多支病变的
临床效果研究[J].,2015,15(28):5535-5538 |
| 不同干预方式及干预时机对急性非ST 段抬高型心肌梗死伴多支病变的
临床效果研究 |
| Research on the Clinical Effect of Different Interventions and OperationalTime of Treatment for Non-ST Segment Acute Elevated MyocardialInfarction with Multivessel Disease |
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| DOI： |
| 中文关键词: 急性非ST 段抬高心肌梗死 冠状动脉旁路移植术 手术时机 经皮冠状动脉介入治疗 肌钙蛋白I 多支病变 |
| 英文关键词: Non-ST segment elevated myocardial infarction (NSTEMI) CABG Operational time PCI CTnI Multivessel disease |
| 基金项目:青岛市公共领域科技支撑计划项目(11-2-3-2-（11）-nsh) |
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| 中文摘要: |
| 目的：评估肌钙蛋白I(cTnI)转归前后经皮冠状动脉介入治疗(percutaneous coronary intervention，PCI)与冠状动脉旁路移植术
(coronary artery bypass grafting，CABG)治疗急性非ST 段抬高心肌梗死(non-ST segment elevated myocardial infarction，NSTEMI)的
有效性及安全性。方法：入选2008 年1 月1 日至2013 年4 月30 日就诊于我院并接受PCI或CABG治疗的NSTEMI患者329
例，分为cTnI转归前PCI 干预组(A 组)、cTnI转归前CABG 干预组(B 组)、cTnI转归后PCI 干预组(C 组)和cTnI 转归后CABG干
预组(D 组)。计算和比较各组的临床终点事件的发生率，再灌注策略对临床终点事件的优势比(OR)。结果：四组患者的完全血运重
建率比较差异有统计学意义(P<0.05)，B、C、D组显著高于A组(P<0.05)，而B、C、D组之间比较无统计学差异(P>0.05)。术后24 个
月，再次血运重建率：A 组12.9%和B 组3.4%(OR=3.82，95%CI：1.03～16.60)，A组12.9%和C 组5.1%(OR=2.55，95%CI：1.29～
6.61)；MACCE事件发生率：A组14.1%和C 组5.9%(OR=2.38，95%CI：1.15～5.79)，以上结果比较差异均有统计学意义(P<0.05)。
结论：cTnI转归后行PCI治疗NSTEMI伴多支病变患者较cTnI转归前PCI更有利于减少MACCE事件和再次血运重建的发生，
cTnI转归前行CABG 术在降低血运重建发生率方面较优于PCI治疗。 |
| 英文摘要: |
| Objective:To evaluate the clinical efficacy and safety of PCI before and after cardiac troponin (cTnI) returned to
normal and CABG in the treatment of non-ST segment elevated myocardial infarction (NSTEMI).Methods:From Jan 1 2008 to Apr 30
2013, 329 patients receiving PCI or CABG in our hospital were screened and enrolled into this study. The patients were divided into four
groups: PCI before cTnI returned to normal (A group), CABG before cTnI returned to normal (B group), PCI after cTnI returned to
normal(C group) and CABG after cTnI returned to normal(D group). The incidences of clinical events of four groups were compared and
the odds ratio (OR)of efficacy and safety endpoints were calculated.Results:There are difference in completeness of reveascularisation
among the four groups (P<0.05), The percentages of complete reveascularisation of group B, C and D were significantly higher than that
of groupA (P<0.05), however, no significant difference was found among the three groups (P>0.05). At 24th month after operation, the
percentages of complete reveascularisation were 12.9% in group A and 3.4% in groupB (OR=3.82, 95% CI: 1.03~16.60), 12.9% in
group A and 5.1% in groupC (OR=2.55, 95% CI: 1.29~6.61), the incidence of MACCE were 14.1% in group A and 5.9% in group C
(OR=2.38, 95% CI: 1.15~5.79)(P<0.05).Conclusion:For NSTEMI patients with multivessel disease, PCI after cTnI return to normal
could be beneficial to reduce the revascularization rates and incidence of MACCE compared with PCI before cTnI return to normal, the
CABG treatment is was superior to PCI before cTnI return to normal in reducing the rates of revascularization. |
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