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目的分析急性ST段抬高心肌梗死(STEMI)合并非梗死相关动脉(non-IRA)慢性完全闭塞(CTO)患者临床特点和急诊经皮冠状动脉介入治疗(PCI)预后。方法 417例STEMI接受直接PCI患者中,53例至少1支non-IRA为CTO(A组),另364例无non-IRA CTO(B组),比较2组病史、介入治疗及其预后。结果 A组陈旧性心肌梗死病史比率(9.4%vs 2.5%,P<0.05)、2型糖尿病病史比率(26.4%vs 12.9%,P<0.05)、应用主动脉内球囊反搏(IABP)率(17.0%vs 8.0%,P<0.05)、临时起搏率(20.8%vs 7.4%,P<0.01)、心脏电复律率(26.4%vs 7.1%,P<0.01)均高于B组;随访期间(至少12个月),A组因心功能不全再次住院率高于B组(28.3%vs 12.9%,P<0.05);2组急性期住院期间病死率分别为3.8%和3.6%,随访期间病死率分别为5.7%和5.5%,2组比较差异均无统计学意义(P均>0.05)。结论 STEMI合并non-IRA CTO患者既往糖尿病、心肌梗死病史多见,病情凶险,借助IABP、心脏电复律、临时起搏治疗多见,但直接PCI仍可明显提高生存率,改善近期、远期预后。
Objective To analyze the clinical features and the prognosis of emergency percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) and chronic non-infarction-related chronic occlusion (CTO). Methods A total of 417 STEMI patients undergoing primary PCI were enrolled. 53 patients with at least one non-IRA CTO (group A) and 364 patients without non-IRA CTO (group B) were included in this study. The medical history, interventional therapy and prognosis were compared between the two groups. Results The prevalence rate of old myocardial infarction in group A was 9.4% vs 2.5% (P <0.05), the history of type 2 diabetes was 26.4% (12.9%, P <0.05). The intra-aortic balloon pump (IABP) (P <0.05). The rate of temporary pacing (20.8% vs 7.4%, P <0.01) and cardioversion rate (26.4% vs 7.1%, P <0.01) During the follow-up period (at least 12 months), the rehospitalization rate of patients with heart failure in group A was higher than that of group B (28.3% vs 12.9%, P <0.05); the mortality rate during hospitalization was 3.8% and 3.6% The case fatality rates during follow-up were 5.7% and 5.5%, respectively, with no significant difference between the two groups (all P> 0.05). Conclusion STEMI with non-IRA CTO patients with previous history of diabetes mellitus and myocardial infarction more common, dangerous, with IABP, cardioversion, temporary pacing treatment more common, but PCI can still significantly improve the survival rate and improve the short-term, long-term Prognosis.