Zhao Wei, Bai Jin, Zhang Fuchun, Guo Lijun, Gao Wei
Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory peptides, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing 100191, China.
J Cardiothorac Surg. 2014 Mar 19;9:50. doi: 10.1186/1749-8090-9-50.
The importance of achieving complete revascularization by percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (MI) on exercise capacity remains unclear.
To compare exercise capacity early after acute ST-elevation myocardial infarction (STEMI), in patients receiving PCI with stenting, between those completely revascularized (CR) and those incompletely revascularized (IR).
We retrospectively reviewed 326 patients [single-vessel disease (SVD) group, 118 patients; multivessel disease (MVD) with CR group, 112 patients; MVD with IR group, 96 patients] who underwent cardiopulmonary exercise testing 7-30 days after STEMI to measure peak oxygen uptake (VO2peak), oxygen uptake at anaerobic threshold (VO2AT), and peak oxygen pulse. Demographic data, presence of concomitant diseases, STEMI characteristics, and echocardiography and angiography findings were evaluated.
Most patients were male (89.0%) and mean age was 55.6 ± 11.2 years. Ischemic ST deviation occurred in 7.1%, with no significant difference between groups. VO2peak and VO2AT did not differ significantly between groups, despite a trend to be lower in the CR and IR groups compared with the SVD group. Peak oxygen pulse was significantly higher in the SVD group than in the IR group (p = 0.005). After adjustment for age, gender, body mass index, cardiovascular risk factors, MI characteristics and echocardiography parameters, CR was not an independent predictor of VO2peak (OR = -0.123, 95% confidence interval [CI] -2.986 to 0.232, p = 0.093), VO2AT (OR = 0.002, 95% CI 1.735 to 1.773, p = 0.983), or peak oxygen pulse (OR = -0.102, 95% CI -1.435 to 0.105, p = 0.090).
CR in patients with STEMI treated with PCI for multivessel disease might show no benefit on short-term exercise tolerance over IR.
经皮冠状动脉介入治疗（PCI）实现急性心肌梗死（MI）患者完全血运重建对运动能力的重要性仍不明确。
比较接受支架置入PCI治疗的急性ST段抬高型心肌梗死（STEMI）患者中，完全血运重建（CR）者与不完全血运重建（IR）者早期的运动能力。
我们回顾性分析了326例患者[单支血管病变（SVD）组118例；多支血管病变（MVD）伴CR组112例；MVD伴IR组96例]，这些患者在STEMI后7 - 30天接受了心肺运动试验，以测量峰值摄氧量（VO2peak）、无氧阈摄氧量（VO2AT）和峰值氧脉搏。评估了人口统计学数据、合并疾病情况、STEMI特征以及超声心动图和血管造影结果。
大多数患者为男性（89.0%），平均年龄为55.6±11.2岁。7.1%的患者出现缺血性ST段压低，组间无显著差异。尽管CR组和IR组与SVD组相比有降低趋势，但组间VO2peak和VO2AT无显著差异。SVD组的峰值氧脉搏显著高于IR组（p = 0.005）。在调整年龄、性别、体重指数、心血管危险因素、MI特征和超声心动图参数后,CR不是VO2peak（OR = -0.123，95%置信区间[CI] -2.986至0.232，p = 0.093）、VO2AT（OR = 0.002，95% CI 1.735至1.773，p = 0.983）或峰值氧脉搏（OR = -0.102，95% CI -1.435至0.105，p = 0.090）的独立预测因素。
在接受PCI治疗的多支血管病变STEMI患者中，CR在短期运动耐量方面可能并不比IR更具优势。
