Zhao Xin, Han Ya-ling, Wang Shou-li, Wang Xiao-zeng, Jing Quan-min, Wang Bin, Wang Geng, Ma Ying-yan, Liu Hai-wei
Department of Cardiology, Institute of Cardiovascular Research of People's Liberation Army, General Hospital of Shenyang Military Region, Shenyang 110840, China.
Zhonghua Yi Xue Za Zhi. 2012 Oct 16;92(38):2685-8.
To evaluate the efficacy and safety of intra-aortic balloon pump (IABP) counter pulsation in the treatment of ST-segment elevation myocardial infarction (STEMI) with concurrent left main coronary artery (LMCA) disease.
A retrospective analysis was performed on 305 patients with confirmed STEMI due to LMCA occlusion (≥ 50%) by coronary angiography. They were divided into IABP and non-IABP groups according to the application of IABP or not. Two groups were further divided into 2 subgroups according to the treatment with percutaneous coronary intervention (PCI) or drug alone. Short and long-term clinical efficacies and the incidence of complications caused by the application of IABP were analyzed in all groups and subgroups.
(1) PCI procedure: Successful rate of immediate post-procedure was 100%. No death, major cardiovascular event and cerebrovascular accident occurred during the procedure. The average number of stents per patient was 2.1 ± 0.7 and the average diameter and length of stent were (3.9 ± 0.6) and (24.2 ± 7.1) mm respectively. (2) SAFETY: No significant difference existed between the IABP and non-IABP groups in in-hospital massive bleeding rate (0.94% vs 1.00%, P > 0.05). However, the IABP group had a higher prevalence of mild in-hospital bleeding than the non-IABP group. (3) In-hospital and long-term major adverse cardiac event (MACE) rate: (1) IABP group had a lower MACE rate (25.3% (24/95) vs 38.5% (57/148), P < 0.05). (2) In spite of IABP implantation, the PCI subgroup had significantly a lower mortality rate than the drug subgroup (7.2% (6/83) vs 25.0% (6/24), P < 0.05). (3) The combined use of PCI and IABP was superior to other regimens with regards to decreasing short and long-term mortality (11.2% (12/107) and 25.3% (50/198), P < 0.01).
PCI is feasible and safe for the STEMI patients with LMCA and better short and long-term efficacies may be achieved. The use of IABP in the treatment of LMCA-related STEMI reduces MACE rate and improves survival rate.
评估主动脉内球囊反搏（IABP）在治疗合并左主干冠状动脉（LMCA）病变的ST段抬高型心肌梗死（STEMI）中的疗效和安全性。
对305例经冠状动脉造影确诊为LMCA闭塞（≥50%）导致STEMI的患者进行回顾性分析。根据是否应用IABP将其分为IABP组和非IABP组。两组再根据经皮冠状动脉介入治疗（PCI）或单纯药物治疗进一步分为2个亚组。分析所有组和亚组中IABP应用后的短期和长期临床疗效及并发症发生率。
（1）PCI手术：术后即刻成功率为100%。术中无死亡、重大心血管事件和脑血管意外发生。每位患者平均植入支架数量为2.1±0.7枚，支架平均直径和长度分别为（3.9±0.6）mm和（24.2±7.1）mm。（2）安全性：IABP组和非IABP组的院内大出血发生率无显著差异（0.94%对1.00%，P>0.05）。然而，IABP组院内轻度出血的发生率高于非IABP组。（3）院内及长期主要不良心脏事件（MACE）发生率：（1）IABP组的MACE发生率较低（25.3%（24/95）对38.5%（57/148），P<0.05）。（2）尽管植入了IABP，但PCI亚组的死亡率显著低于药物亚组（7.2%（6/83）对25.0%（6/24），P<0.05）。（3）在降低短期和长期死亡率方面，PCI与IABP联合应用优于其他治疗方案（11.2%（12/107）和25.3%（50/198），P<0.01）。
PCI治疗合并LMCA的STEMI患者是可行且安全的，可取得较好的短期和长期疗效。IABP用于治疗与LMCA相关的STEMI可降低MACE发生率并提高生存率。
