不完全纠正心肌缺血对接受血管重建术患者长期预后的影响

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目的:冠心病患者是否针对心肌灌注显像(MPI)心肌缺血节段所对应的冠状动脉病变均接受了血管重建术(RVS),比较其预后的不同,与根据冠状动脉造影(CAG)显示的冠状动脉病变是否得到完全血管化治疗的预后进行对比研究,探讨两种不同影像技术对指导RVS治疗方案制定的临床价值。方法:对2007-10至2010-12期间在阜外医院行MPI提示有心肌缺血,并在3个月内在我院接受RVS的患者进行回顾性随访。共202例患者入选,根据CAG标准将患者分为完全血管化组(CAG_(CR)组,n=99)和不完全血管化组(CAG_(IR)组,n=103)。根据MPI心肌缺血节段所对应的冠状动脉病变是否均接受RVS,分为心肌缺血完全纠正组(MPI_(CR)组,n=112)和心肌缺血不完全纠正组(MPI_(IR)组,n=90)。死亡为第一随访终点,主要不良心血管事件(MACE,包括死亡、急性心肌梗死或再次RVS)为第二随访终点。随访时间为(46±21)个月。结果:CAG_(CR)组的死亡率低于CAG_(IR)组[4.0%(4/99) vs 11.7%(12/103),P=0.025],CAG_(CR)组与CAG_(IR)组的MACE发生率的差异无统计学意义[15.4%(15/99) vs 18.5%(19/103),P=0.28]。MPICR组的死亡率[3.6%(4/112) vs 13.3%(12/90),P=0.005]和MACE发生率[12.6%(14/112) vs 22.6%(20/90),P=0.004]均明显低于MPI_(IR)组。Cox多因素回归分析显示MPI指导下的心肌缺血纠正不完全是预测死亡的独立危险因子[危险比(HR)=4.02,95%可信区间(CI):1.13~12.55,P=0.017]和预测MACE的唯一独立危险因子(HR=2.67,95%CI:1.31~5.40,P=0.006)。结论:对有心肌缺血接受RVS的冠心病患者,应该重视针对心肌缺血节段所对应的“罪犯血管”早期进行完全血管化治疗,达到完全纠正和改善心肌缺血,从而改善患者的长期预后。 Objectives: Coronary artery disease patients underwent myocardial revascularization (RVS) for coronary artery lesions corresponding to myocardial ischemic segments in myocardial perfusion imaging (MPI). We compared their prognosis with coronary artery angiography (CAG) Coronary artery disease whether the prognosis of complete vascularization compared to study the two different imaging techniques to guide the development of RVS treatment of clinical value. Methods: Retrospective follow-up was performed on MPI-prompted myocardial ischemia in Fu Wai Hospital from 2007-10 to 2010-12 and within 3 months for RVS in our hospital. A total of 202 patients were enrolled. According to the CAG criteria, patients were divided into two groups: CAG (CR) group (n = 99) and CAG (n = 103). According to whether MPI_ (CR) group (n = 112) and myocardial ischemia incomplete correction group (MPI_ (IR)) were included in the study, Group, n = 90). Mortality was at the end of the first follow-up and major adverse cardiovascular events (MACE, including death, acute myocardial infarction, or RVS) were the second follow-up. The follow-up time was (46 ± 21) months. Results: The mortality of CAG-CR group was lower than that of CAG-IR group [4.0% (4/99) vs 11.7% (12/103), P = 0.025] The incidence of MACE was not significantly different (15.4% (15/99) vs 18.5% (19/103), P = 0.28]. Mortality rates in the MPICR group [3.6% (4/112) vs 13.3% (12/90), P = 0.005] and MACE incidence [12.6% (14/112) vs 22.6% (20/90) ] Were significantly lower than the MPI_ (IR) group. Cox multivariate regression analysis showed incomplete correction of myocardial ischemia under MPI was an independent predictor of mortality (hazard ratio (HR) = 4.02, 95% CI: 1.13-12.55, P = 0.017] and The only independent risk factor for MACE was predicted (HR = 2.67, 95% CI: 1.31 to 5.40, P = 0.006). Conclusion: In patients with coronary artery disease with myocardial ischemia and RVS, we should pay more attention to the early complete vascularization of the “culprit vessel” corresponding to myocardial ischemia to achieve complete correction and improvement of myocardial ischemia, so as to improve the patients Long-term prognosis.
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