| Background:Coronary heart disease(CHD)is one of the diseases harmful to human health.Along with the growth in the living standard of people in our country and the transformation of the lifestyle,and especially the increase of a series of problems like aging of population,high blood pressure,hyperlipidemia and diabetes etc,CHD has taken on the features of gradual rejuvenation of onset age,increase of incident number and increasing complexity of vessels’ pathological changes etc.clinically.Meanwhile,the proportion of multi-vessel lesions in coronary artery lesions discovered by coronary angiogram has also increased gradually.It has been confirmed via clinical study that coronary multi-vessel lesion is the primary cause of CHD patients’ heart failure,and also one of the factors to influence patients’ prognosis.Along with the development of medical science,the therapies of CHD have been increasingly abundant.Application of percutaneous coronary intervention(PCI)in particular has greatly changed the clinical effect of patients with CHD,multi-vessel lesion and complex lesion in particular,and occurrence rate of adverse event has dropped significantly.However,so far,there has been a relatively big discrepancy between the method of only treating the vessel lesion(namely so-called “culprit vessel”)mostly related to the latest attack and the method of treating all the vessel lesions at one time or sequentially by several times considering PCI’s treatment of patients with multi-vessel lesions.American College of Cardiology(ACC)and American Heart Association(AHA)have brought forward clinical instructions on treatment strategy of multi-vessel lesions of patients with acute myocardial infarction,but there is no consensus on how to treat coronary triple vessel lesion of patients with non-myocardial infarction CHD.Some believe it is enough to only treat “culprit” vessel,but some hold this is not enough and only by disposing of all significant stenotic lesions can patients be truly benefited.This research has provided a basis for exploring patients with coronary triple vessel lesions and formulating reasonable interventional therapy specific to the prognostic observation of two different therapies.Objective:This research explored the optimal strategy of PCI treatment of patients with coronary multi-vessel lesions by comparing the occurrence of MACE between PCI pure treatment of “culprit” vessel of patients with coronary triple vessel lesions and complete vascularization(at one time or several times)within one year.Method:In this research,580 patients who were admitted to the Third Hospital of Hebei Medical University between Jan.,2010 and Jan.,2014,and were diagnosed with coronary triple vessel lesions via coronary angiogram were selected.There were 386 males and 194 females aged from 45 to 86.Patients with LM lesions and STEMI were excluded.According to the treatment strategy adopted in the operation,patients were divided into pure “culprit” vessel treatment group(Group A)and complete vascularization(at one time or several times within 1 month to 3 months)treatment group(Group B).There were 332 cases in Group A and 248 cases in Group B.After the operation,patients were given regular antiplatelet,lipid regulation and crown extension treatment,incidence rate of MACE such as stenocardia,myocardial infarction,stent thrombosis,revascularization,bleeding,heart failure and death(cardiogenic or non-cardiogenic)etc.within one year was observed.Results:In pure culprit vessel treatment group(Group A),there were respectively 110,6 and 6 patients who had stenocardia,myocardial infarction and heart failure,accounting for respectively 33.1%,1.8% and 1.8% of Group A’s headcount;in complete vascularization treatment group(Group B),there were respectively 48,11 and 5 patients who had stenocardia,myocardial infarction and heart failure,accounting for respectively 19.4%,4.4% and 2.0% of Group B’s headcount.There were respectively 10 and 17 patients of revascularization in Group A and Group B,accounting for respectively 3.0% and 6.9% of the headcount.There were respectively 39 and 3 patients who had bleeding and stent thrombosis in Group A,accounting for respectively 11.7% and 0.9% of Group A’s headcount.There were respectively 53 and 9 patients who had bleeding and stent thrombosis in Group B,accounting for respectively 21.4% and 3.6% of Group B’s headcount.Within one year of follow-up visit,there was one case of cardiac death in Group A and none of non-cardiac death;there were three cases of cardiac death in Group B and one case of non-cardiac death.After statistical analysis,value P of stenocardia,stent thrombosis,revascularization and bleeding was respectively less than 0.001,0.047,0.030 and 0.002,which were all less than 0.05 with statistical difference.However,value P of myocardial infarction,heart failure and death was respectively 0.063,0.855 and 0.216,which were all bigger than 0.05 without statistical difference.Conclusion:After the operation,occurrence rate of stenocardia in Group A is higher than that in Group B;there are no significant differences between two groups concerning occurrence rate of myocardial infarction,heart failure and death after the operation;however,after the operation,occurrence rate of stent thrombosis,revascularization and bleeding in Group A is lower than that in Group B. |
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