2022 年第 9 期 第 17 卷

完全血运重建策略对老年非ST段抬高型心肌梗死合并多支血管病变患者临床预后的影响

Prognostic significance of complete revascularization strategy in elderly patients with non-ST-elevation myocardial infarction complicated with multivessel disease

作者：严研公威王晓范婧尧郑文阙斌艾辉聂绍平

英文作者：Yan Yan Gong Wei Wang Xiao Fan Jingyao Zheng Wen Que Bin Ai Hui Nie Shaoping

单位：首都医科大学附属北京安贞医院心内冠心病中心，北京100029

英文单位：Coronary Heart Disease Center Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：非ST段抬高型心肌梗死；老年医学；完全血运重建

英文关键词：Non-ST-segmentelevationmyocardialinfarction;Geriatrics;Completerevascularization

• 摘要：

• 目的 探讨完全血运重建策略对老年非ST段抬高型心肌梗死（NSTEMI）合并多支血管病变患者临床预后的影响。方法  基于国际多中心BleeMACS注册登记数据库，收集2003—2014年908例老年NSTEMI合并多支血管病变患者的资料。根据血运重建策略，将患者分为完全血运重建组和非完全血运重建组。收集患者的人口学信息、既往病史等基线资料以及心肌再梗死、出血、心力衰竭、输血、死亡等事件的发生情况。根据既往病史及用药情况等进行倾向性评分调整。分析完全血运重建策略对老年NSTEMI合并多支血管病变患者临床预后的影响。结果  908例老年NSTEMI合并多支血管病变患者中，完全血运重建组391例（43.1%）、非完全血运重建组517例（56.9%）。倾向性评分模型匹配后，2组各纳入364例患者，2组基线资料比较差异均无统计学意义（均P＞0.05）。2组住院期间心肌再梗死、出血、心力衰竭及输血事件发生率比较差异均无统计学意义（均P＞0.05）。完全血运重建组NSTEMI后1年主要不良心血管事件（MACE）、全因死亡及心肌再梗死发生率均低于非完全血运重建组，差异均有统计学意义（均P＜0.05），1年内发生MACE风险低于非完全血运重建组（风险比=0.53，95%置信区间：0.37~0.77），累积无MACE生存率高于非完全血运重建组（Log-rank P＜0.01）。倾向性评分模型匹配后，完全血运重建组NSTEMI后1年MACE、心肌再梗死发生率仍低于非完全血运重建组（均P＜0.05），后1年内发生MACE风险低于非完全血运重建组（风险比=0.64，95%置信区间：0.43~0.95），累积无MACE生存率高于非完全血运重建组（Log-rank P=0.02）。结论 完全血运重建策略可显著改善老年NSTEMI合并多支血管病变患者的远期预后。

• Objective  To investigate the prognostic significance of complete revascularization strategy in elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) complicated with multivessel disease. Methods  Based on international multi-center BleeMACS registry, data of 908 elderly patients with NSTEMI complicated with multivessel disease were collected from 2003 to 2014. According to complete revascularization strategy or not, patients were divided into complete revascularization group and non-complete revascularization group. Baseline characteristics such as demographic information and past medical history, as well as clinical events such as myocardial reinfarction, bleeding, heart failure, blood transfusion and death were collected. Propensity score matching was performed based on past medical history, medication use and so on. The influence of complete revascularization strategy on prognosis in elderly patients with NSTEMI complicated with multivessel disease was analyzed. Results  Of 908 elderly patients with NSTEMI complicated with multivessel disease, 391 (43.1%) were involved in complete revascularization group, and 517 (56.9%) were involved in incomplete revascularization group. After propensity score matching, 364 cases were involved in each of the two groups, and there were no significant differences in baseline data between the two groups (all P>0.05). There were no significant differences in the rates of in-hospital myocardial reinfarction, bleeding, heart failure, and transfusion between the two groups (all P>0.05). Within 1 year after NSTEMI, incidences of major adverse cardiovascular events (MACE), all-cause death and myocardial reinfarction in complete revascularization group were lower than those in incomplete revascularization group (all P<0.05); the risk of MACE in complete revascularization group was lower than that in incomplete revascularization group (hazard ratio=0.53, 95% confidence interval: 0.37-0.77), and cumulative MACE free survival was higher than that in incomplete revascularization group (Log-rank P＜0.01). After propensity score matching, incidences of MACE and myocardial reinfarction in complete revascularization group were lower than those in incomplete revascularization group within 1 year after NSTEMI (all P<0.05); the risk of MACE in complete revascularization group was lower than that in incomplete revascularization group (hazard ratio=0.64, 95% confidence interval: 0.43-0.95), and cumulative MACE free survival was higher than that in incomplete revascularization group (Log-rank P=0.02). Conclusions  Long-term prognostic benefit of complete revascularization was observed in elderly patients with NSTEMI complicated with multivessel disease.