不同冠状动脉重建术治疗急性ST段抬高心肌梗死临床效果研究

Research on the Clinical Effect of Different Coronary Revascularization in Patients with ST Segment Elevation Myocardial Infarction

摘要: 目的：评估经皮冠状动脉介入(percutaneous coronary intervention, PCI)及冠状动脉旁路移植术(coronary artery bypass grafting, CABG)治疗急性ST段抬高心肌梗死(ST segment elevated myo-cardial infarction, STEMI)的有效性及安全性。方法：入选我院2009.1~2015.1 ST段抬高型心肌梗死(STEMI)后接受PCI或CABG治疗的120例患者，分为PCI干预组(A组)、CABG干预组(B组)，比较两组患者的一般临床资料、冠状动脉造影血管病变情况及心源性病死率、心律失常、再发心绞痛以及再入院率和再次血运重建术率，术后随访24个月。结果：CABG组三支和左主干冠状动脉病变例数明显高于PCI组(70.91% vs. 13.85%, 16.36% vs. 1.54%, P < 0.05)，随访24个月两组患者在心源性病死率、合并心律失常、再次住院率及再次血管重建术发生率(P > 0.05)差异无统计学意义。PCI和CABG两组在心绞痛复发和IABP应用上有差异，具有统计学意义(16.92% vs. 3.64%, 4.62% vs. 18.18%, P < 0.05)。结论：PCI与CABG是治疗STEMI患者重要的血运重建方式，CABG较PCI在完全血运重建、减少心绞痛复发方面更有优势，根据患者的一般状况和冠脉病变情况采用合理的血运重建方式，以达到最佳重建冠状动脉血流的结果，改善患者的预后。

Abstract: Objective: To compare the clinical efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in treating patients with ST segment elevation myocardial infarction (STEMI). Methods: From Jan. 1 2009 to Jan. 1 2015, 120 STEMI patients receiving PCI or CABG at our institution were screened and enrolled into this study. Patients were classified into two groups: A (PCI), B (CABG). General clinical data, angiographic characteristics, cardiac death rate, angina reoccurrence, re-revascularization, re-hospitalization were recorded and analyzed in hospital and during 24 months’ follow-up. Result: Rates of tri-vessel disease and left main artery disease were significantly higher in CABG group than in PCI group (70.91% vs. 13.85%, 16.36% vs. 1.54%, P < 0.05), no significant difference was observed in the rates of cardiac death, arrhythmia, coronary re-revascularization between 2 groups (P > 0.05). The difference between the two groups of PCI and CABG in the recurrence of angina pectoris and the use of IABP was statistically significant (16.92% vs. 3.64%, 4.62% vs. 18.18%). Conclusions: PCI and CABG are both safe strategies treating STEAMI patients. CABG is superior in complete revascularization and reduction of recurrence angina compared with PCI. To obtain optimal revascularization results and to improve clinical prognosis, we should choose the strategy according to the specific clinical and coronary characteristics of the patient.