摘要
目的:探讨不同血运重建方式对急性心肌梗死(AMI)冠状动脉多支病变合并糖尿病患者产生的预后差异。方法:回顾性纳入2022年1月至2024年6月兰州大学第一医院心内科收治的AMI冠状动脉多支病变合并糖尿病患者438例。根据不同血运重建方式分为不完全血运重建(NCR)组(n=166)、分期完全血运重建(SCR)组(n=152)和即刻完全血运重建(ICR)组(n=120)。记录并比较各组患者的基线临床特征、冠状动脉造影资料和术后用药情况。随访终点事件为主要不良心脑血管事件(MACCE),MACCE包括全因死亡、心原性死亡、非致死性心肌梗死、计划外的再次血运重建及脑卒中。采用Kaplan-Meier曲线描述3组MACCE累积发生率,应用log-rank检验分析3组MACCE累积发生率差异的显著性。运用Cox回归分析患者预后不良的影响因素。结果:NCR组、SCR组和ICR组间,既往经皮冠状动脉介入治疗史、术中冠状动脉血管内超声使用情况、对比剂使用量,差异均有统计学意义(P均<0.05)。中位随访21(11,25)个月期间,NCR组59例(35.5%),SCR组26例(17.1%),ICR组30例(25.0%)发生MACCE。Kaplan-Meier曲线显示,3组间MACCE累积发生率的差异有统计学意义(log-rank P<0.001);采用Bonferroni校正(校正后α′=0.05/3≈0.0167)两两比较发现,NCR组与SCR组(log-rank P<0.001)、ICR组(log-rank P=0.011)比较差异均有统计学意义,SCR组与ICR组比较差异无统计学意义(log-rank P=0.228)。多因素Cox回归分析显示,既往高血压病史是AMI冠状动脉多支病变合并糖尿病患者发生MACCE的独立危险因素(HR=1.71,95%CI:1.10~2.64,P<0.05);与NCR比,SCR可进一步降低MACCE累积发生率(HR=0.45,95%CI:0.28~0.73,P=0.001)。结论:推荐SCR作为AMI冠状动脉多支血管病变合并糖尿病患者优先的血运重建方式。对合并高血压的患者应加强血压管理,降低MACCE发生风险。
Objectives:To investigate the prognostic difference of different revascularization strategies in AMI patients with multi-vessel disease and diabetes.Methods:AMI patients with multi-vessel disease and diabetes admitted to the Department of Cardiology of the First Hospital of Lanzhou University from January 2022 to June 2024 were retrospectively included.Patients were divided into non complete revascularization(NCR)group(n=166),staged complete revascularization(SCR)group(n=152)and immediate complete revascularization(ICR)group(n=120).Baseline clinical characteristics,coronary angiography data and postoperative medication were compared among the groups.Primary endpoint was the major adverse cardiovascular and cerebrovascular events(MACCE)during follow-up.MACCE includes all-cause mortality,cardiogenic mortality,non-fatal myocardial infarction,unplanned revascularization and stroke.The log-rank test was used to analyze the significance of the differences in the cumulative incidence of MACCE among the three groups.Cox regression was used to explore the influencing factors of poor prognosis in patients.Results:There were statistically significant differences among NCR group,SCR group and ICR group in terms of the history of previous percutaneous coronary intervention,the use of intraoperative coronary intravascular ultrasound(IVUS)and the dosage of contrast agent(all P<0.05).During a median follow-up of 21(11,25)months,MACCE events occurred in 59 cases(35.5%)in the NCR group,26 cases(17.1%)in the SCR group,and 30 cases(25.0%)in the ICR group.The Kaplan-Meier curve showed that the differences in the cumulative incidence of MACCE among the three groups were statistically significant(log-rank P<0.001).Using the Bonferroni correction(adjustedα′=0.05/3≈0.0167),pairwise comparisons revealed statistically significant differences between the NCR and SCR groups(log-rank P<0.001)and between the NCR and ICR groups(log-rank P=0.011).However,no statistically significant difference was observed between the SCR and ICR groups(log-rank P=0.228).Cox multivariate regression analysis demonstrated that history of hypertension was an independent risk factor for MACCE in AMI patients with multivessel coronary artery disease and diabetes(HR=1.71,95%CI:1.10-2.64,P<0.05).The difference in the incidence of MACCE between the SCR group and the NCR group was statistically significant(HR=0.45,95%CI:0.28-0.73,P=0.001).Conclusions:Staged complete revascularization serves as the preferred revascularization strategy for AMI patients with multivessel coronary disease and diabetes mellitus.Additionally,for patients with concomitant hypertension,blood pressure management should be intensified to reduce the risk of MACCE.
作者
门冰欣
胡娜娜
张亚苹
张军兰
师晓雷
张锦
MEN Bingxin;HU Nana;ZHANG Yaping;ZHANG Junlan;SHI Xiaolei;ZHANG Jin(Department of Internal Medicine,The First Clinical College of Medicine,Lanzhou University,Lanzhou 730000,China;Department of Cardiology,The First Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《中国循环杂志》
北大核心
2025年第11期1081-1087,共7页
Chinese Circulation Journal
基金
甘肃省自然科学基金(22JR11RA018)。
关键词
急性心肌梗死
冠状动脉多支病变
2型糖尿病
经皮冠状动脉介入治疗
acute myocardial infarction
coronary multi-vessel disease
type 2 diabetes
percutaneous coronary intervention
