单支或多支血管病变年轻患者经皮冠状动脉介入治疗后临床特征及预后的比较评估
Comparative assessment of clinical profile and outcomes after primary percutaneous coronary intervention in young patients with single multivessel disease.
作者信息
Muhammad Atif Sher, Ashraf Tariq, Mir Ayaz, Alishan Syed, Farooq Faiza, Ammar Ali, Karim Musa, Rizvi Syed Nadeem Hassan, Saghir Tahir, Sial Jawaid Akbar, Khan Naveed Ullah
机构信息
Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan.
Department of Clinical Research, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan.
出版信息
World J Cardiol. 2020 Apr 26;12(4):136-143. doi: 10.4330/wjc.v12.i4.136.
BACKGROUND
Even though percutaneous coronary intervention (PCI) improved the survival of patients with acute myocardial infarction, still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease (SVD).
AIM
To compare the clinical profile and outcomes after the primary PCI in young patients with SVD multivessel disease (MVD).
METHODS
The retrospective cohort of patients were divided into two groups: SVD and MVD group. The study population consisted of both male and female young (≤ 45 years) patients presented with ST-elevation myocardial infarction (STEMI) at the National Institute of Cardiovascular Disease, Karachi, Pakistan and undergone primary PCI from 1 July 2017 to 31 March 2018. Pre and post-procedure management of the patients was as per the guidelines and institutional protocols.
RESULTS
A total of 571 patients with STEMI, ≤ 45 years were stratified into two groups by the number of vessels involved, 342 (59.9%) with SVD and 229 (40.1%) with MVD. The average age of these patients was 39.04 ± 4.86 years. A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group (25.1% 38%, < 0.01; 11.7% 27.5%, < 0.001) respectively. While, smoking was more prevalent among the SVD group as compare to MVD group (36.3% 28.4%, = 0.05). The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group (48.8% 39.2%, = 0.021). Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98% 96.5% of the patients is SVD MVD group.
CONCLUSION
The MVD comprised of around 40% of the young patients presented with STEMI. Also, this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases, therefore, preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.
背景
尽管经皮冠状动脉介入治疗（PCI）提高了急性心肌梗死患者的生存率，但多支冠状动脉疾病仍是影响预后的重要因素，与单支血管疾病（SVD）相比，其预后更差。
目的
比较年轻SVD和多支血管疾病（MVD）患者接受直接PCI后的临床特征和预后。
方法
回顾性队列研究的患者分为两组：SVD组和MVD组。研究人群包括2017年7月1日至2018年3月31日在巴基斯坦卡拉奇国家心血管病研究所就诊的年龄≤45岁的男性和女性ST段抬高型心肌梗死（STEMI）患者，并接受了直接PCI。患者术前和术后的管理均按照指南和机构方案进行。
结果
共有571例年龄≤45岁的STEMI患者根据受累血管数量分为两组，342例（59.9%）为SVD，229例（40.1%）为MVD。这些患者的平均年龄为39.04±4.86岁。与MVD组相比，SVD组高血压和糖尿病的患病率较低（分别为25.1%对38%，P<0.01；11.7%对27.5%，P<0.001）。然而，与MVD组相比，SVD组吸烟更为普遍（36.3%对28.4%，P=0.05）。与SVD组相比，年轻MVD患者中观察到的高危病变数量明显更多（48.8%对39.2%，P=0.021）。术后心肌梗死溶栓血流分级与病变血管数量无关，P值为0.426，SVD组和MVD组分别有98%和96.5%的患者观察到心肌梗死溶栓血流分级为Ⅲ级。
结论
MVD约占年轻STEMI患者的40%。此外，本研究表明糖尿病和高血压在多支血管疾病的发病机制中具有一定作用，因此，糖尿病和高血压的预防措施可能是减轻过早发生STEMI负担的有效策略。
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