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目的观察直接经皮冠状动脉介入术(p PCI)治疗左主干(LMCA)急性闭塞致ST段抬高型心肌梗死(STEMI)患者的临床疗效。方法在全军心血管介入诊疗管理系统数据库中选取罪犯病变为LMCA(LM组)和非LMCA(n LM组)急性闭塞所导致STEMI的患者行p PCI的临床资料,对比分析两组患者临床特征的差异,以探讨罪犯病变部位不同对患者临床预后的影响。结果本研究共纳入8 878例STEMI患者(LM组147例;n LM组8 731例),两组STEMI患者均接受p PCI。两组患者高脂血症、吸烟及高血压病比例比较,差异无统计学意义(P>0.05)。但LM组患者的心功能Ⅲ~Ⅳ级比例明显高于n LM组患者(13.6%比4.2%,P<0.01)。两组STEMI患者症状到血流开通时间比较,差异无统计学意义(P>0.05)。虽然LM组患者术中主动脉内囊反搏支持及盐酸替罗非班使用比例明显高于n LM组(P<0.01),但LM组患者的围术期心源性病死率仍然明显高于n LM组(P<0.01)。结论与非LMCA患者比较,尽管LMCA患者的围术期心源性病死率较高,但初步结果提示,LMCA急性闭塞导致STEMI接受p PCI治疗患者的住院疗效尚可接受,其长期疗效还需进一步随访观察。
Objective To observe the clinical effect of direct percutaneous coronary intervention (PCI) in the treatment of acute myocardial infarction (STEMI) caused by left main trunk (LMCA) occlusion. Methods The clinical data of patients with STEMI who underwent acute occlusion of LMCA (LM group) and non-LMCA (n LM group) were enrolled in the PLA Cardiovascular Intervention Management System database. The clinical data of two groups were compared In order to explore the impact of different parts of the criminals on the clinical prognosis of patients. Results A total of 878 STEMI patients (147 in the LM group and 8 731 in the n LM group) were enrolled in this study. All patients with STEMI received p PCI. Two groups of patients with hyperlipidemia, smoking and hypertension ratio, the difference was not statistically significant (P> 0.05). However, the ratio of cardiac function grade Ⅲ ~ Ⅳ in LM group was significantly higher than that in n LM group (13.6% vs. 4.2%, P <0.01). There was no significant difference between the two groups in symptom onset time of STEMI and blood flow (P> 0.05). Although the ratio of intra-aortic balloon catheterization and tirofiban in LM group was significantly higher than that of n LM group (P <0.01), the perioperative CFR of LM group was still significantly higher than that of n LM group n LM group (P <0.01). CONCLUSIONS: Compared with non-LMCA patients, although the perioperative cardiogenic mortality is high in patients with LMCA, the preliminary results suggest that the hospitalization of STEMI patients receiving p PCI due to acute occlusion of LMCA is acceptable and the long-term efficacy needs further Follow-up observation.