RESUMO
Objective To evaluate the effect of SYNTAX score in the emergency revascularization strategy selection in ST‐segment elevation myocardial infarction patients with multi‐vessel disease(MVD) and to analyze the patient′s prognosis and influen‐cing factors .Methods A total of 144 patients with STEMI complicating MVD verified by coronary arterial angiography in the Xin‐qiao Hospital of Third Military Medical University from August 2010 to March 2012 were collected and divided into the once com‐plete revascularization group (CR group) ,staged complete revascularization group (SR group) and incomplete revascularization group (IR group) according to different emergency PCI strategies .The basic clinical conditions and coronary arterial SYNTAX score were recorded .The occurrence rate of major adverse cardiovascular events (MACCE) during 12 months follow up period was performed the statistics .The results of coronary arterial angiography were collected .The effect of different strategy on prognosis and the risk factors affecting prognosis were analyzed .Results There was no statistically significant difference in the all‐cause mor‐tality between the IR group with the CR and SR groups (P>0 .05) ,while the cerebrovascular event ,repeat revascularization during hospitalization ,AMI and total MACCE occurrence rate had statistical difference between the IR group with the CR and SR groups (P 0 .05) ,while which in moderate lesion had statistical difference among 3 groups(P<0 .05) ,the CR group had the highest occurrence rate of MACCE . Conclusion For the patients with STEMI complicating MVD ,the SYNTAX score can be used as the evidence for selecting reperfu‐sion strategies and applied in emergency PCI .
RESUMO
Objective To survey ST-segment resolution in STEMI patients undergoing emergency percutaneous coronary intervention (PCI) and to find the specific clinical features of patients with inadequate ST-segment resolution.Methods A total of 198 patients were divided into two groups according to the ratio of ST-segment resolution:relatively adequate ST-segment resolution group (＞ 50％) and inadequate STsegment resolution group (＜ 50％).The clinical features,infarct-related artery and PCI-related evants were evaluated,and major adverse cardiovascular events (MACE including target vessel revascularization,recurrent myocardial infarction,or death) were recorded during hospitalization and follow-up period.Multivariate logistic analysis was used to identify relevant factors influencing ST-segment resolution of STEMI patients after treatment with PCI.The Statistical analyses of data were carried out using SPSS 10.0 software.Results (1) There were 156 patients with relativey adequate ST-segment resolution and 42 patients with inadequate ST-segment resolution.Of them,there were higher percentage of patients aged over 75years in the inadequate ST-segment resolution group than those in the relatively adequate ST-segment resolution group (9 cases,21.4％ vs.14 cases,9.0％ ; P ＜0.05).(2) In inadequate ST-segment resolution group,thetotal ischemic time was significant longer [(5.2 ±2.2) h vs.(3.0 ± 1.6) h,P ＜0.01].The infarctrelated artery (IRA) was more common at left anterior descending coronary artery (LAD) (27 cases,64.3％ vs.69 cases,44.2％; P ＜ 0.05) and there were fewer patients with TIM grade 3 of IRA in inadequate ST-segment resolution group after primary PCI than that in relative adequate ST-segment resolution group (32 cases,76.2％ vs.140 cases,89.7％ ; P ＜ 0.05).There was a lower rate of using GP Ⅱ b/Ⅲ a receptor antagonist and a higher rate of prescribing IABP in inadequate ST-segment resolution group.(3) There is a higher incidence of MACE during hospitalization and follow-up period in patients with inadequate ST-segment resolution.(4) Multivariate logistic analysis indicated that age over 75 years,LAD occlusion,the total ischemic time were related to ST-segment resolution.Conclusions The patients with age over 75 years,LAD occlusion,longer ischemia time,and unemployment GP Ⅱ b/Ⅲ a receptor antagonist before PCI were prone to get inadequate ST-segment resolution and poor prognosis.Age over 75 years,LAD occlusion,and longer ischemic time were independent risk factors of the inadequate ST-segment resolution in STEMI patients after emergency PCI.