摘要
Abstract
Objective To investigate the effect of treatment of proximal and distal non-infarct-related artery (IRA) lesions on no-reflow phenomenon and short-term prognosis in patients with ST-elevation acute myocardial infarction (STEMI).Methods A total of 110 STEMI patients with two or more IRA lesions were treated with percutaneous coronary intervention (PCI) by our Cardiology Department from January 2007 to June 2011.Seven cases with non-IRA lesions in both proximal and distal IRA were excluded.One hundred and three patients were randomly divided into group A (simultaneous treatment of proximal non-IRA lesions,48 cases) and group B (simultaneous treatment of distal non-IRA lesions,55 cases).Observations were performed on clinical indices,including postoperative thrombolysis in myocardial infarction (TIMI) and TIMI myocardial perfusion (TMP) grades,the decline degree of ST segment on electrocardiogram,peak values of myocardial injury markers,echocardiographic indices of cardiac function at discharge,and the incidence of in-hospital major adverse cardiac events (MACE).Results Compared with group A,group B had significantly higher incidence rates of postoperative TIMI 3 and TMP 3 flow (77.08％ vs 89.09％,x2=2.682,P＜0.05;60.42％ vs 76.34％,x2=7.909,P＜0.05).The decline degree of ST segment in group B was significantly higher than that in group A (t =-5.725,P＜0.05).Group B had significantly lower peak values of creatine phosphokinase isoenzyme and troponin T than group A (t =8.370,8.563;P＜0.05).Left ventricular ejection fraction at discharge in group B was significantly higher than that in group A (t =-8.253,P＜0.05).Compared with group A,group B had significantly lower left ventricular endsystolic diameter and left ventricular end-diastolic diameter at discharge in group B (t =8.568,6.182;P ＜0.05).Group B also had a significantly lower incidence of in-hospital MACE than group A (x2 =6.867,P＜0.05).Conclusion In patients with STEMI undergoing primary PCI,treatment of non-IRA lesions in proximal IRA may be more likely to cause no-reflow phenomenon,have an adverse effect on left ventricular function,and increase the incidence of in-hospital MACE.关键词
心肌梗死/冠状动脉疾病/血管成形术,气囊,冠状动脉/无复流现象/治疗结果Key words
myocardial infarction/coronary artery disease/angioplasty, balloon, coronary/no-reflow phenomenon/treatment outcome分类
医药卫生
