不同血管急性下壁心肌梗死老年患者直接PCI术后短期预后分析.docVIP

不同血管的急性下壁心肌梗死老年患者直接PCI术后短期预后分析 　　[摘要] 目的 探讨急性下壁ST段抬高型心肌梗死（STEMI）行直接经皮冠状动脉介入治疗（pPCI）的老年患者，不同罪犯血管（IRA）对短期临床预后的影响。 方法 选择2015年1月～2016年4月徐州医科大学附属医院心内科行pPCI的下壁STEMI并成功开通靶血管的老年患者（≥60岁）133例。根据IRA不同将患者分为右冠状动脉组（RCA组，103例）和左回旋支组（LCX组，30例）。收集所有入选患者一般临床资料并随访患者术后30 d内主要不良心血管事件（MACE），包括心源性死亡、心力衰竭/心源性休克、恶性心律失常及靶血管血运重建。 结果 RCA组术后7 d及随访30 d后所测得LVEF明显低于LCX组[（47.1±8.4）%比（53.4±7.1）%，（49.5±8.9）%比（56.3±6.9%）]，差异有统计学意义（P 0.05）。RCA组随访期内共出现45例MACE事件，而LCX组MACE事件仅6例，RCA组MACE事件发生率明显高于LCX组（43.7%比20.0%），差异有统计学意义（P 0.05）。 结论 IRA为RCA的下壁STEMI老年患者短期临床预后较LCX者差。 　　[关键词] 老年患者；下壁心肌梗死；直接经皮冠状动脉介入治疗；罪犯血管；短期预后 　　[中图分类号] R542.22 [文献标识码] A [文章编号] 1673-7210（2017）05（b）-0056-04 　　[Abstract] Objective To investigate the elderly patients short-term clinical prognosis of acute inferior wall ST-segment elevation myocardial infarction （STEMI） with different infarct-related artery （IRA） undergoing primary percutaneous coronary intervention （pPCI）. Methods From January 2015 to April 2016， in Department of Cardiology of Affiliated Hospital of Xuzhou Medical University， 133 elderly patients （≥60 years） with the inferior wall STEMI undergoing pPCI successfully were selected. According to difference of IRA， the enrolled elderly patients were divided into rightcoronary artery group （RCA group， n = 103） and left circumflex group （LCX group， n = 30）. The patients general clinical characteristic， and all patients followed up within 30 d of major adverse cardiovascular events （MACE）， including cardiacdeath， heart failure or cardiogenic shock， malignant arrhythmia and target vessel revascularization were collected. Results LVEF of RCA group after operation 7 d and follow-up 30 d were significantly lower than those of LCX group [（47.1±8.4）% vs （53.4±7.1）%， （49.5±8.9）% vs （56.3±6.9）%，]， the differences were statistically significant （P 0.05）. During the follow-up period， there were 45 MACE case in the group RCA， only 6 MACE cases in the group LCX. incidence of MACE in two groups was compared （43.7% vs 20.0%）， the difference