病人属于易损状态(斑块、血液),non-IRA慢血流和无复流发生概率增加,可能造成梗死面积扩大?抗血小板治疗不充分,支架内血栓风险增加?冠脉痉挛-高估非梗死相关血管狭窄程度?增加处于危险状态的缺血心肌?延长手术时间?增加造影剂用量和造影剂肾病?增加放射线照射量РToma M, et al. Eur Heart J 2010;31:1701-1707Р10%Р41%Р(Assessment of Pexelizumab in Acute Myocardial Infarction)? MVD = >70% DS in > 2 major epicardial vesselsР90天死亡率: ?SVD 3.1% vs MVD 6.3% ?p<0.001РSTEMI+MVD是否干预非梗死相关血管??Non-IRA PCI: APEX-AMIРSTEMI+MVD是否干预非梗死相关血管??Non-IRA PCI: APEX-AMIРToma M, et al. Eur Heart J 2010;31:1701-1707РNon-IRA-PCI: 12.5%РIRA-Only PCI: 5.6%Рp< 0.001РNon-IRA-PCI: 17.4%Рp= 0.02РIRA-Only PCI: 12%Р死亡率(%)Р死亡/心衰/休克(%)РDays to FUРDays to FUР干预非梗死相关血管增加90天死亡率РToma M, et al. Eur Heart J 2010;31:1701-1707РNon-IRA-PCI BetterРIRA-Only-PCI BetterРUnadjusted and Propensity Score-Adjusted Mortality and MACEРSTEMI+MVD是否干预非梗死相关血管??Non-IRA PCI: APEX-AMI
全文预览