主动脉内球囊反搏术对STEMI合并左主干病变疗效分析

目的探讨主动脉内球囊反搏术辅助治疗急性ST段抬高心肌梗死(STEMI)合并左主干病变患者的近期和远期疗效.方法选取225例经冠脉造影证实为左主干病变STEMI患者,根据左主干病变和患者病情决定是否行主动脉内球囊反搏术,分为主动脉内球囊反搏术组89例、非主动脉内球囊反搏术组136例;每组再分为2个亚组,PCI组和药物治疗组.比较各组近期和远期的治疗效果、并发症发生情况.结果主动脉内球囊反搏术组患者的发病时间、左室舒张末期内径以及KillipⅢ~Ⅳ级、心源性休克、室性心律失常、急性肺水肿的比例明显高于非主动脉内球囊反搏术组患者,左室射血分数明显低于非主动脉内球囊反搏术组患者,以上差异均具有显著统计学意义(P0.01).主动脉内球囊反搏术组患者病变狭窄程度、中度以上钙化率、合并2支或3支血管病变率均明显高于非主动脉内球囊反搏术组患者(P0.05).PCI手术即刻成功率100%,平均每例患者植入支架(2.3±0.9)枚.主动脉内球囊反搏术组轻微出血发生率为14.6%,高于非主动脉内球囊反搏术组的6.6%(P0.05);大出血发生率两组间比较差异无统计学意义(P0.05).主动脉内球囊反搏术组住院期间死亡率明显低于非主动脉内球囊反搏术组,PCI治疗组死亡率明显低于药物治疗组(P0.01);主动脉内球囊反搏术联合PCI治疗后患者死亡率明显低于其他各组(P0.01).结论主动脉内球囊反搏术辅助治疗STEMI合并左主干病变可有效降低心脏不良事件发生率,提高患者近期和远期生存率.

Curative Efficacy of Intra-Aortic Balloon Counterpulsation on the Treatment of STEMI in Patients with Left Main Coronary Artery Disease

Objective To investigate the short-term and long-term effects of intra-aortic balloon counterpulsation as adjuvant therapy on the treatment of acute ST-segment elevation myocardial infarction ( STEMI) with left main coronary artery disease. Method 225 patients who were confirmed to be left main coronary artery disease combined with STEMI by coronary angiography were enrolled in this study. The patients were divided into surgery group (89 cases) and non-surgery group (136 cases) according to the left main coronary artery disease and the patient’s condition. Then each group was randomly divided into two subgroups,PCI group and drug treatment group. The therapeutic effects and complications of each group in short-term and long-term were compared. Results Compared with the non-surgery group,the onset of disease,left ventricular end diastolic diameter,KillipⅢ~Ⅳ, cardiac shock, ventricular arrhythmia, and proportion of acute pulmonary edema of the surgery group were significantly higher,while the left ventricular ejection fraction was obviously lower (P<0. 01). The stenosis degree,moderate or above calcification,and combination rates of 2 or 3 vessel lesions of the surgery group were significantly higher than the non-surgery group (P<0. 05). The immediate success rate of PCI was 100%,and the average number of stent implantation was (2. 3 ±0. 9) per patient. The minor bleeding rate of the surgery group (14. 6%) was much higher than that of the non-surgery group (6. 6%) (P<0. 05),while the difference in sever hemorrhage was not significant ( P>0 . 05 ) . The death rate of the surgery group was obviously lower than that of the non-surgery group,and the mortality rate of PCI group was significantly lower than that of the drug treatment group (P<0. 01),and the mortality rate of the combination treatment group was the lowest among of the other groups ( P<0 . 01 ) . Conclusion Intra-aortic balloon counterpulsation as adjuvant therapy for treatment of STEMI with left main coronary artery disease can effectively reduce the incidence of adverse cardiac events,and improve the short-term and long-term survival rate of patients.