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目的 探讨急性前壁与非前壁急性心肌梗死（AMI）患者直接经皮冠状动脉介入干预（PCI）后临床远期预后。方法 连续行直接PCI的287例AMI患者根据心肌梗死的不同部位分成急性前壁心肌梗死组（AW-AMI组,142例）和急性非前壁心肌梗死组（NAW-AMI组,145例）,分析其临床基本特征、冠状动脉病变特点,主要观察终点为住院期病死率与随访期（平均17.3±9.8个月）主要心血管事件（MACE）,包括非致命心肌梗死,非致命心力衰竭,靶血管血运重建及总心脏性死亡的发生率。结果 与NAW-AMI组比较,AW-AMI组的CK与CK-MB峰值显著升高[（3 533±2 888）U/L比（2322±1638）U/L,（158±197）U/L比（95±64）U/L,P均<0.01],左室射血分数降低（0.55±0.13比0.61±0.12,P<0.05）以及住院期病死率增高（4.1％比0,P<0.05）。平均随访17.3±9.8）个月,AW-AMI组的非致命性心力衰竭、总心脏死亡率及复合终点事件发生率高于NAW-AMI组（P均<0.05）。多变量分析显示,前壁心肌梗死和前降支近段病变与AMI患者直接PCI治疗后心脏性死亡发生相关（P均<0.05）。结论 前壁心肌梗死与主要心血管事件发生率增高有关,AW-AMI行直接PCI患者的长期临床预后较NAW-AMI行直接PCI者差。
Objective To investigate the clinical long-term prognosis of patients with acute anterior wall and non-anterior wall acute myocardial infarction (AMI) after direct percutaneous coronary intervention (PCI). Methods A total of 287 AMI patients undergoing direct PCI were divided into acute anterior myocardial infarction group (AW-AMI group, 142 cases) and acute non-anterior myocardial infarction group (NAW-AMI group, 145 cases) according to the different parts of myocardial infarction. The clinical features and the characteristics of coronary lesions were analyzed. The main end points were major cardiovascular events (MACE), including in-hospital mortality and follow-up (mean 17.3 ± 9.8 months), including nonfatal myocardial infarction, nonfatal heart failure, Revascularization and Total Cardiac Death Rates. Results Compared with the NAW-AMI group, the peak values of CK and CK-MB in AW-AMI group were significantly higher than those of the NAW-AMI group [(3 533 ± 2 888) U / L vs 2322 ± 1638 U / L, (158 ± 197) U / (95 ± 64) U / L, P <0.01, LV ejection fraction decreased (0.55 ± 0.13 vs 0.61 ± 0.12, P <0.05) and hospitalization mortality increased (4.1% vs 0, P < 0.05). The average incidence of nonfatal heart failure, total cardiac death and composite end point in AW-AMI group was higher than that in NAW-AMI group (all P <0.05) after a mean follow-up of 17.3 ± 9.8 months. Multivariate analysis showed that the incidence of myocardial infarction in anterior myocardial infarction and proximal anterior descending artery was related to cardiac death after PCI in patients with AMI (all P <0.05). Conclusions Anterior myocardial infarction is associated with an increased incidence of major cardiovascular events. Long-term clinical outcomes in patients with direct-PCI of AW-AMI are worse than those of direct-PCI in NAW-AMI.