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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2010年第3期

页码:

379-381,389

栏目:

临床研究

出版日期:

2010-04-06

文章信息/Info

Title:

Therapeutic strategy for ST-segment elevation myocardial infarction in young and middle-aged patients

作者:

王海燕¹; 杨鹏飞²; 薛玉生¹; 郑强荪¹; 汤雁玲¹; 王毅¹

1.第四军医大学唐都医院心脏内科，陕西 西安 710038；2.渭南市妇幼保健院，陕西 渭南 714000

Author(s):

WANG Hai-yan¹;  YANG Peng-fei²;  XUE Yu-sheng¹;  ZHENG Qiang-sun¹;  TANG Yan-ling¹;  WANG Yi¹

1.Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, Shaanxi, China; 2.Weinan Maternal and Child Hygiene Hospital, Weinan 714000, Shaanxi, China

关键词:

心肌梗死; 急性; 中青年; 治疗策略; 冠状动脉介入治疗; 溶栓治疗

Keywords:

acute myocardial infarction;  young and middle-aged patients;  therapeutic strategy;  percutaneous coronary intervention;  thrombolysis

分类号:

R541.4

DOI:

-

文献标识码:

A

摘要:

目的: 通过分析青中年ST段抬高型心肌梗死（STEMI）患者的冠状动脉造影（CAG）结果，初步探讨这类人群的最佳冠脉再通策略。方法: 2007年1月～2008年10月224位因STEMI在第四军医大学唐都医院心脏内科行冠状动脉介入治疗（PCI）术的患者，入院后给与静脉溶栓或经皮球囊扩张术（PTCA）的首次再通治疗，根据其后8 d的CAG结果将患者分为支架植入组（n=160，男/女＝132/28）和未植入支架组（n=64，男/女＝64/0）。分析比较两组患者的基本情况、临床表现、病变情况以及首次再通治疗后8 d和6个月的CAG情况。结果：①未植入支架组患者年龄 （32±3）岁，显著小于支架植入组（58±7）岁，P<0.01；男性患者比例显著增高；并发糖尿病、高血压病、高血脂症患者的比例和体质量指数均显著低于植入支架组；无1例既往发生过心梗或心绞痛症状；疲劳和饮酒是其发病的主要诱因（均P<0.01）。②首次血管再通治疗后8 d CAG结果：未植入支架组全部是前降支单支病变，而植入支架组有148例患者为多支病变（P<0.01）；受累血管的前向血流未植入支架组全部达到TIMI Ⅲ级，植入支架组仅有88例患者（P<0.01）；受累血管管腔狭窄程度前者为（37±10）%，显著轻于后者（82±8）%，P<0.01。6个月CAG复查结果：受累血管的前向血流两组患者均达到TIMI Ⅲ级；管腔狭窄程度两组无显著差异，而且未植入支架组的管腔狭窄程度显著优于首次血管再通治疗后（P<0.01）。结论: 对下列患者植入支架应慎重： ①年龄≤40岁；②梗塞血管再通后CAG示：受累血管壁光滑且管腔狭窄≤50%；③无其他需要行PCI处理的冠脉血管病变。

Abstract:

AIM: To study the therapeutic strategy for ST-segment elevation myocardial infarction (STEMI) in young and middle-aged patients by analyzing the characteristics of the culprit vessel revealed by coronary angiography (CAG). METHODS: A total of 224 patients with STEMI being treated at the Tangdu Hospital, Fourth Military Medical University were divided into stent group (n=160, M/F=132/28) and non-stent group (n=64, M/F=64/0) according to the characteristics of the culprit vessel in CAG 8 days after primary percutaneous transluminal coronary angioplasty (PTCA) or thrombolysis. The basic conditions, clinical manifestations, coronary lesion characteristics, predisposing factors and results of the CAG 8 days and 6 months after primary revascularization were observed and compared between groups. RESULTS: Compared with patients in the stent group, patients who had no pectoris in the non-stent group were significantly younger in age (P<0.01). There were more male patients and fewer patients with diabetes, hyperlipidemia and hypertension were observed. Fatigue and alcohol were the major predisposing factors. Results of the CAG 8 days after primary revascularization indicated that patients in the non-stent group all suffered from single-vessel coronary disease of the anterior descending branch, whereas 148 patients in the stent-implanted group suffered from multi-vessel coronary disease (P<0.01). The culprit vessel in all cases in the non-stent group reached TIMI grade 3, whereas only 88 cases in the stent group reached TIMI grade 3. Mean luminal diameter stenosis of the culprit vessel in the non-stent group was (0.37±0.10) mm, greater than in the stent group (0.82±0.08) mm, P<0.01. Results of the CAG 6 months after primary revascularization indicated that the mean luminal diameter stenosis of the culprit vessel was smaller than it was 8 days after primary revascularization in the non-stent group (P<0.01). CONCLUSION: This study suggests that stent implantation should be cautiously used in patients ≤40 years of age and with smooth luminal surface and diameter stenosis ≤50% or in patients with no other coronary lesions for stent implantation.

参考文献/References

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备注/Memo

备注/Memo:

收稿日期：2009-09-22.作者简介：王海燕，主治医师，博士Email:whyzhh@fmmu.edu.cn

常用功能

更新日期/Last Update: 2010-04-09