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ST 段抬高型急性心肌梗死加速非罪犯冠状动脉病变的粥样硬化。

ST elevation acute myocardial infarction accelerates non-culprit coronary lesion atherosclerosis.

机构信息

Department of Cardiology, Chinese PLA General Hospital, Beijing, China.

出版信息

Int J Cardiovasc Imaging. 2014 Feb;30(2):253-61. doi: 10.1007/s10554-013-0354-z. Epub 2014 Jan 14.

Abstract

The previously study found, using a mouse model, that acute myocardial infarction accelerated atherosclerosis. This study assessed whether ST elevation myocardial infarction (STEMI) accelerates the progression of non-culprit coronary lesion (NCCL) in patients who underwent percutaneous coronary interventions (PCI). Four hundred and forty-nine patients who underwent successful PCI with stents and follow-up coronary angiography in a single center were enrolled. The NCCL progression was assessed using three-dimensional quantitative coronary angiography and was defined as ≥10 % diameter reduction of a preexisting stenosis ≥50, ≥30 % diameter reduction of a stenosis <50 %, development of a new stenosis ≥30 % in a previously normal segment, or progression to total occlusion. The patients were classified into two groups according to whether the progression existed or not. The median age of patients was 58.4 years. The mean angiographic follow-up period was 12.3 months, 134 (29.8 %) patients had NCCL progression. Multivariate Cox regression analysis (step-wise) showed that STEMI was the only independent determinant of NCCL progression. Compared to the other coronary artery disease group, the crude hazard ratio (HR) of NCCL progression for the STEMI group was 3.20 (95 % CI 2.27-4.50; p < 0.001), and the association remained significantly after adjustment for age, sex, BMI, SBP, DBP, serum lipids, fasting blood glucose, peak monocyte count, smoking, drinking, hypertension, diabetes mellitus and lesion characteristics of NCCL (adjusted HR 3.56, 95 % CI 2.41-5.27; p < 0.001). The ST elevation acute myocardial infarction accelerates non-culprit coronary lesion atherosclerosis.

摘要

先前的研究发现,在小鼠模型中,急性心肌梗死加速了动脉粥样硬化的发展。本研究评估了经皮冠状动脉介入治疗(PCI)后,ST 段抬高型心肌梗死(STEMI)是否会加速非罪犯冠状动脉病变(NCCL)的进展。在一家中心,共纳入了 449 名接受成功 PCI 治疗并接受后续冠状动脉造影的患者。使用三维定量冠状动脉造影评估 NCCL 进展,定义为:原有狭窄≥50%的病变进展≥10%、狭窄<50%的病变进展≥30%、原有正常节段进展≥30%的新狭窄或进展为完全闭塞。根据是否存在进展,将患者分为两组。患者的中位年龄为 58.4 岁。平均血管造影随访时间为 12.3 个月,134 例(29.8%)患者出现 NCCL 进展。多变量 Cox 回归分析(逐步法)显示,STEMI 是 NCCL 进展的唯一独立决定因素。与其他冠状动脉疾病组相比,STEMI 组 NCCL 进展的粗危险比(HR)为 3.20(95%CI 2.27-4.50;p<0.001),调整年龄、性别、BMI、SBP、DBP、血脂、空腹血糖、单核细胞峰值计数、吸烟、饮酒、高血压、糖尿病和 NCCL 病变特征后,这种关联仍然显著(调整 HR 3.56,95%CI 2.41-5.27;p<0.001)。ST 段抬高的急性心肌梗死加速了非罪犯冠状动脉病变的动脉粥样硬化。

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