王超.罪犯血管自发再通改善急性ST段抬高型心肌梗死患者临床预后[J].内科急危重症杂志,2022,28(3):215-219
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| DOI：10.11768/nkjwzzzz20220310 |
| 中文关键词: 急性ST段抬高型心肌梗死 自发再通 经皮冠状动脉介入治疗 临床特征 预后 |
| 英文关键词: |
| 基金项目:武汉市卫生健康科研基金资助（No：WG20D13)；武汉市卫生计生委医学科研项目（No：WX18Q08) |
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| 中文摘要: |
| 目的:分析急性ST段抬高型心肌梗死（STEMI）患者罪犯血管自发再通（SR）的临床和造影特征，并评价其临床预后。方法:连续入选符合条件的STEMI患者共302例，根据冠状动脉造影结果分为SR组和非SR组，所有患者均行急诊经皮冠状动脉介入（PCI）治疗，分析2组临床和造影特点。平均随访时间为（15±7）个月，应用Kaplan-Meiers生存曲线分析SR对急性STEMI患者无心血管不良事件（MACE）生存的影响。结果:SR组梗死前心绞痛、胸痛缓解、T波倒置、罪犯血管中远段病变比例、入院左心室射血分数（LVEF）和随访LVEF高于非SR组，血栓抽吸比例、肌钙蛋白I （cTNI）峰值、超敏C反应蛋白（hs-CRP）、随访左心室舒张末期内径（LVEDD）低于非SR组（P均＜0.05）。SR组院内MACE低于非SR组（16.4% vs 37.4%，P＝0.001）。Kaplan-Meiers生存分析显示SR组（Log Rank=4.187，P=0.041）外院随访无MACE生存率高于非SR组（P＜0.05）。结论:急性STEMI罪犯血管SR的患者具有更多梗死前心绞痛及胸痛缓解、T波倒置多见、罪犯病变距离冠状动脉开口远、血栓负荷小、炎症反应轻和心肌梗死面积小等临床特征，其短期和远期预后相对较好。 |
| 英文摘要: |
| Objective: To analyze the clinical and angiographic features of criminal spontaneous recanalization (SR) in patients with acute ST-segment elevation myocardial infarction (STEMI), and evaluate the clinical prognosis. Methods: Totally, 302 STEMI patients were enrolled consecutively, divided into SR group and non-SR group according to the results of coronary angiography. All patients were treated by emergency percutaneous coronary intervention (PCI). The clinical and angiographic characteristics of the two groups were analyzed. The mean follow-up time was (15±7) months, and Kaplan-Meiers survival curve was used to analyze the effect of SR on survival without major adverse cardiovascular events (MACE) in patients with acute STEMI. Results: The proportion of angina pectoris before infarction, relief of chest pain, T wave inversion, middle-far vascular lesions of criminals, left ventricular ejection fraction (LVEF) on admission and LVEF during follow-up in the SR group were higher than those in the non-SR group, and the proportion of thrombus aspiration, cardiac troponin I (cTNI) peak, hypersensitive C-reactive protein (hs-CRP), and left ventricular end diastolic diameter (LVEDD) during follow-up was lower than that in the non-SR group(all P< 0.05). The incidence of nosocomial MACE in the SR group was lower than that in the non-SR group (16.4% vs 37.4%, P= 0.001). Kaplan-Meiers survival analysis showed that the MACE free survival rate in the SR group (Log Rank= 4.187, P= 0.041) was higher than that in the non-SR group. Conclusion: Patients with acute STEMI criminal vascular SR had clinical features, including: more pre-infarction angina pectoris, relief of chest pain, T wave inversion, long distance from criminal lesion to coronary artery opening, less thrombotic load, less inflammatory response and small myocardial infarction size,whose short-term and long-term prognosis will be relatively good. |
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