2022 年第 2 期 第 17 卷

急性ST段抬高型心肌梗死合并冠状动脉多支病变患者直接经皮冠状动脉介入术中支架后扩张对预后的影响

Effect of stent post dilation on prognosis in patient with acute ST-segment elevation myocardial infarction and coronary artery multivessel lesions during primary percutaneous coronary intervention

作者：赵春勇1靳晓宇2许丁1金洪珍1严研3聂绍平3

英文作者：Zhao Chunyong1 Jin Xiaoyu2 Xu Ding1 Jin Hongzhen1 Yan Yan3 Nie Shaoping3

单位：1首都医科大学附属北京友谊医院平谷医院心内科，北京101200；2北京市平谷区刘家店社区卫生服务中心，北京101206；3首都医科大学附属北京安贞医院心内科，北京100029

英文单位：1Department of Cardiology Pinggu Hospital Beijing Friendship Hospital Capital Medical University Beijing 101200， China; 2Liujiadian Community Health Service Center Pinggu District Beijing 101206， China; 3Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性ST段抬高型心肌梗死；经皮冠状动脉介入；后扩张 

英文关键词：AcuteST-segmentelevationmyocardialinfarction;Percutaneouscoronaryintervention;Postdilatation

• 摘要：

• 目的  探讨急性ST段抬高型心肌梗死（STEMI）合并冠状动脉多支病变患者直接经皮冠状动脉介入（pPCI）术中支架后扩张对预后的影响。方法  选取首都医科大学附属北京安贞医院2008—2018年收治的STEMI合并冠状动脉多支病变行pPCI的患者1 081例，根据支架置入后是否行后扩张分为后扩张组（455例）和未后扩张组（626例）。收集患者住院数据，术后随访，记录心肌缺血相关的胸痛、胸闷症状发生情况和终点事件。比较2组一般临床资料，pPCI相关指标、近期预后（院内事件、心功能Killip分级、出院左心室射血分数、住院时间），随访期间缺血性胸闷、胸痛和冠状动脉造影支架内再狭窄发生情况。结果  2组基本情况和既往史、辅助检查、冠状动脉造影和围术期药物应用情况比较差异均无统计学意义（均P＞0.05）。后扩张组起病至pPCI时间和支架总长均长于未后扩张组，置入支架数量多于未后扩张组，重叠支架、预扩张比例高于未后扩张组，血栓抽吸比例低于未后扩张组（均P＜0.05），2组分叉支架比例比较差异无统计学意义（P＞0.05）。未后扩张组住院时间长于后扩张组（P＜0.05），2组院内事件发生情况、心功能Killip分级和出院左心室射血分数比较差异均无统计学意义（均P＞0.05）。2组共333例患者完成随访，其中未后扩张组224例，后扩张组109例。pPCI术中未后扩张组随访缺血性胸闷、胸痛，支架内再狭窄＞0、＞50%、＞75%的发生率均高于后扩张组［63.4%(142/224)比22.9%（25/109）、54.0%（121/224）比25.7%（28/109）、50.9%（114/224）比16.5%（18/109）、41.1%（92/224）比4.6%（5/109）］（均P＜0.001）。结论  STEMI合并冠状动脉多支病变患者pPCI时行支架后扩张与未后扩张具有相似的效果和安全性，后扩张可减少患者住院时间，降低远期胸闷、胸痛发作和支架内再狭窄发生率，改善远期预后。

• Objective To investigate the effect of stent post dilatation on the prognosis in patients with acute ST segment elevation myocardial infarction (STEMI) complicated coronary artery with multivessel lesions during primary percutaneous coronary intervention (pPCI). Methods Total 1 081 patients with STEMI complicated with coronary artery multivessel lesions who underwent pPCI in Beijing Anzhen Hospital, Capital Medical University from 2008 to 2018 were selected. They were divided into post dilation group (455 cases) and non post dilation group (626 cases) according to whether post dilation was performed after stents implantation. The inpatient data were collected and patients were followed-up after operation. The occurrence of chest pain and chest tightness symptoms and end events related to myocardial ischemia were recorded. The general clinical data, pPCI related indexes, short-term prognosis ［in-hospital events, Killip grade of cardiac function, left ventricular ejection fraction(LVEF) at discharge, length of stay］, ischemic chest tightness, chest pain and in stent restenosis during follow-up were compared between the two groups. Results There were no significant differences between the two groups in basic information, previous history, auxiliary examination Results , coronary angiography Results  and perioperative drug application (all P>0.05). The time from onset to pPCI and the total length of stents in the post dilation group were longer than those in the non post dilation group, the number of stents was more than that in the non post dilation group, the proportions of overlapping stents and pre-dilation were higher than those in the non post dilation group, and the proportion of thrombus aspiration was lower than that in the non post dilation group (all P<0.05). There was no significant difference in the proportion of bifurcated stent between the two groups (P>0.05). The length of stay in the non post dilation group was longer than that in the post dilation group (P<0.05). There were no significant difference in the incidences of in-hospital events, Killip grade of cardiac function and LVEF at discharge between the two groups (all P>0.05). A total of 333 patients were followed-up, including 224 cases in non post dilation group and 109 cases in post dilation group. Incidences of ischemic chest tightness/chest pain and stent restenosis >0, >50% and >75% during follow-up in non post dilation group were higher than those in post dilation group［63.4%(142/224) vs 22.9%(25/109), 54.0%(121/224) vs 25.7%(28/109), 50.9%(114/224) vs 16.5%(18/109), 41.1%(92/224) vs 4.6%(5/109)］ (all P<0.001). Conclusions Stent post dilatation in patients with STEMI complicated with coronary artery multivessel lesions during PCI has similar effect and safety as that without post dilatation. Stent post dilatation can shourten the length of stay, reduce the incidences of long-term chest tightness/chest pain and stent restenosis, and improve the long-term prognosis.