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目的观察急性心肌梗死多支病变患者急诊经皮冠状动脉介入(PCI)手术开通梗死相关动脉(IRA)狭窄后,剩余非IRA严重狭窄再次PCI或药物治疗对预后的影响。方法选取2002—2006年上海交通大学附属第六人民医院及普陀区中心医院诊治的急性心肌梗死多支病变患者190例,一组(129例)仅对罪犯血管实行了再血管化;另一组(61例)实行分期介入手术达到完全再血管化,随访2组患者预后。结果仅处理罪犯血管组平均年龄高(P<0.05)。随访期间死亡事件发生率高(P<0.05)。在高危患者亚组,完全再血管化组预后好。在低危亚组,两组预后差异无统计学意义。结论对于急性心肌梗死多支病变高危患者,应尽可能对大于70%的狭窄实行完全再血管化。对于非高危且不伴有明显缺血症状的患者对其非IRA病变采用保守治疗可达到与完全再血管化治疗类似的效果。
Objective To observe the effect of PCI or drug therapy on the prognosis of severe non-IRA severe stenosis after acute percutaneous coronary intervention (PCI) in patients with multivessel disease of acute myocardial infarction after open infarction-related artery (IRA) stenosis. Methods Totally 190 patients with multi-vessel disease of acute myocardial infarction diagnosed and treated in the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University and the Central Hospital of Putuo District from 2002 to 2006 were selected. One group (129 cases) only had revascularization of the criminals’ blood vessels. The other group (61 cases) underwent phacoemulsification to achieve complete revascularization. The prognosis of the two groups was followed up. The results only deal with criminals vascular group average age (P <0.05). The incidence of death during follow-up was high (P <0.05). In the subgroup of high-risk patients, the complete revascularization group had a good prognosis. In the low-risk subgroup, there was no significant difference in prognosis between the two groups. Conclusions For patients at high risk for MI with acute myocardial infarction, complete revascularization should be performed for stenoses greater than 70% as much as possible. In non-high-risk patients with no obvious ischemic symptoms, conservative treatment of non-IRA lesions can achieve similar effects as complete revascularization.