| Objective:To study the influence of different revascularization strategies on the long-term efficacy of patients with non-ST-segment elevation myocardial infarction with multi-vessel disease and the relationship between clinical risk factors and efficacy.Methods:A retrospective study was performed on 124 patients with non-ST-segment elevation myocardial infarction diagnosed as multi-vessel lesions by coronary angiography in The Cardiovascular Hospital of the Third Affiliated Hospital of Yan’an University from January 2018 to December 2018.Among them,22 patients were excluded because they did not meet the criteria of inclusion,and 102 patients were finally included.The clinical data of the enrolled patients were recorded in detail.According to different revascularization strategies,patients were divided into complete revascularization group(43 cases)and incomplete revascularization group(59 cases),and the effects of different revascularization strategies on the long-term efficacy of non-ST-segment elevation myocardial infarction with multi-vessel lesions and the correlation between clinical risk factors and long-term efficacy were analyzed and compared.Results:(1)The mean age of the enrolled patients was 61.68 years old,with the oldest being 83 years old and the youngest being 36 years old.There are 82 male patients,accounting for about 80.4%;The average BMI of the enrolled patients was about24.38kg/m~2;There were 64 smokers,accounting for about 62.7%;There are 49 people with hypertension,accounting for about 48.0%;The total number of people suffering from diabetes was 19,accounting for about 18.6%.(2)The comparison of clinical data and laboratory examination results showed that there were significant differences in age(t=-2.817,P=0.006),lipoprotein a level(t=-2.365,P=0.020)and NT-pro BNP level(t=-2.148,P=0.034)between the two groups(P<0.05);Others were compared with gender,BMI,smoking history,hypertension,diabetes,admission Killip classification,heart rate,systolic blood pressure,LVEDD,LVEF,WBC,LDL-C,TC,HDL,N-HDL,HB,Hs-Cn I,and the level of D-dimer.There was no significant difference between the two groups(P>0.05).(3)The comparison of CAG and stent implantation between the two groups showed that there was no significant difference in the number and distribution of diseased vessels between the two groups(P>0.05).The number of stent implantation in the complete revascularization group was more than that in the incomplete revascularization group(t=6.723,P=0.000).There was significant difference between the two groups(P<0.05).(4)There was no significant difference in cardiac ejection fraction between the two groups(P>0.05);The cardiac ejection fraction in the complete revascularization group was significantly higher than that in the incomplete revascularization group at 6 months(t=2.256,P=0.026)and 1 year(t=2.790,P=0.006)(P<0.05),it shows that interventional treatment of all diseased vessels can improve cardiac function in patients with non-ST-segment elevation myocardial infarction with multi vessel disease.(5)The comparison of follow-up results between the two groups showed that there was no significance in revascularization,recurrent myocardial infarction,cardiac death,all-cause death,bleeding,recurrence of angina pectoris and arrhythmia(P>0.05);And heart failure rehospitalization(χ~2=4.646,P=0.031)and mace events(χ~2=8.424,P=0.004),and there was significant difference(P<0.05);In terms of mace events,the incidence of mace events in patients with incomplete revascularization strategy was 30.5%(18/59),which was much higher than 7.0%(3/43)in patients with complete revascularization strategy.(6)Multivariate logistic regression analysis of mace events showed that NT-pro BNP level(OR=1.001,95%CI 1.000～1.001,P=0.002)and revascularization strategy(OR=0.247,95%CI 0.064～0.954,P=0.043)were the main risk factors of mace events after revascularization in patients with non-ST-elevation myocardial infarction complicated with multivessel lesions.Conclusion:(1)Total revascularization in patients with non-ST-segment elevation myocardial infarction complicated with multi-vessel disease can improve LVEF value and cardiac function.(2)A complete revascularization strategy can reduce the incidence of MACE events in patients with non-ST-segment elevation myocardial infarction complicated with multi-vessel disease during 3-year follow-up.(3)Revascularization strategy and NT-pro BNP level were independent risk factors for MACE events in patients with non-ST-segment elevation myocardial infarction complicated with multi-vessel lesions during follow-up. |
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